Charlie Rose Memorial Fund Scholarship Request Form
To Be considered for funding: (1) Please complete this form in entirety. (2) Attach the first 2 pages of your most recent tax returns.
Email *
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Participant's Name *
Participant's Address *
Program *
Date of Birth *
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Age *
Applicant Name *
Applicant Address *
Phone *
what other scholarship funds have you inquired about or received (including in the past?) *
Family Composition *
Family Resources (please include gross salaries, principle of savings and/or investment accounts) *
Household Rent Amount or Value of Home and Amount of Outstanding Mortgage, if any: *
Scholarship Request Amount *
Please include additional information for Endeavor to share with the scholarship committee about why you are requesting this scholarship and the reason equine assisted services are currently outside of your budget.
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Please Attach the first 2 pages of your most recent tax returns *
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