1.4 Challenge Alaska Scholarship Form

Challenge Alaska Scholarship Request Form

Who will be participating?

Adult

Signee Information

First Name *

Last Name *

Mobile Number *

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Enter your mobile number to receive sms text alerts.

Email Address *

Program Requesting Scholarship For*

Program Cost (before scholarship)*

Amount of Scholarship Reqeusted*

Reason for Scholarship Reqeust*

FOR STAFF USE ONLY

Date Met With Challenge Alaska Staff

Staff Notes

Approved

Staff Approving

Executive Director Approval

Sign Here

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.

1.4 Challenge Alaska Scholarship Form

Who will be participating?

Signee Information

FOR STAFF USE ONLY

Please enter participants' full names: