Scholarship Award Request

All requests for scholarship awards needs to include post secondary verification documents. Acceptable documents include: Transcripts, finiancial statements, or enrollment letters. Document must have the name of the accredited institution and the name of the student. If one document does not include both, two documents may be submitted.

Scholarship funds will be mailed to the address listed by recipient below. Please ensure this address is accurate for delivery.

Name

First Name Last Name

Email

example@example.com

Phone Number

Date of Birth

Date

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Year Scholarship Awarded

Transcripts, Enrollment Documents, etc...

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I agree that all information provided is true and correct to the best of my knolwedge, and any misrepresentation may eliminate me from scholarship consideration. If selected, I agree that my name will be released publicly on ARCHA website & social media.

Applicant's Signature

Clear

Name of Applicant

First Name Last Name

Date Signed by Applicant

Date

Roger Heintz Youth Scholarship

Scholarship Information

Required Attachments