Connecticut Roller Derby Cindy Luberto Scholarship for Women Identifying/Non Binary Athletes - 2019 - Recommendation Form
Please provide this form to a coach or advisor who can attest to your athletic participation and provide a brief recommendation for the CTRD Scholarship. This recommendation may be submitted online at www.ctrollerderby.com or may be sent directly to scholarship@ctrollerderby.com.

*Past or current members of CTRD or the immediate family of any current CTRD member are ineligible.
Deadline/How to submit:
* Submit all materials by May 17th, 2019. Application online is at www.ctrollerderby.com, but also may be submitted by email to scholarship@ctrollerderby.com or by mail to CT Roller Derby Scholarship, PO Box 1774, Naugatuck, CT 06770.

Email address *
Student Name: *
Coach / Advisor Name: *
Title/ Relationship : *
Years known: *
Phone: *
I understand all personal information will be protected and will not be given or sold to any third parties. *
Please briefly describe the applicant's participation in sport(s) and how her passion and performance is unique. *
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This form was created inside of CT Roller Derby, Inc..