EAA 1093 Scholarship Application

EAA 1093 Scholarship Application
Name*

First NameLast Name
Birthdate*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Occupation:
If you are a student, please type "student" and provide current grade level
I am applying for a scholarship to be used toward:*

Private Pilot RatingInstrument Pilot RatingOther Pilot Rating or Endorsement (please explain below)Mechanic Rating (A, P, A&P, IA, Avionics Technician)Other
Other pilot rating or endorsement:*
I have received Number hours of instruction fromName of School or CFI* .
Contact information of CFI/Flight School: Email , Area Code* Phone Number*
I hold the following medical type: *
My medical expires on:*

MonthDayYear
Date
My interest and goals in aviaiton are:*
I am applying for a specific amount of money*
The amount of money I am applying for and its specific purpose is:*
I have previously applied for a scholarship from EAA 1093.*

TrueFalse
I acknowledge the reporting and volunteer requirements of scholarship recipients and agree to abide by them.
I acknowledge the time commitment required to obtain my desired license and confirm my intention to dedicate the necessary time and energy to my training.