Application Form

BILL ROGERS MEMORIAL SCHOLARSHIP

This Scholarship is available to all residents of Colorado pursuing undergraduate, graduate, or technical degrees, with preference given to members of the Colorado Trappers and Predator Hunters Association or immediate family.

General Information:

NAME:

First                              Last                                       Middle

_______________/___________________________/_______________

Address:   Street/P.O. Box  ___________________________________________________________

City/Town                           State                               Postal Code

__________________/__________________________/______________

Phone:                                            Date & Place of Birth

Day Time                                     Date                City/Town

___________________/___________________/___________________

Evening                                     Name of parent or Guardian

_________________/__________________________________________

Cell                       Family member belonging to the CTPHA

______________/_____________________________________________

Email Address____________________________________________

Undergraduate /Graduate/Technical plans:

Post Secondary Institute:________________________________

Program Name and Length:_____________________________

Tuition Fee:____________________________________________

Approximate Cost of Books & Supplies:_________________

SCHOLASTIC ACHIEVEMENT: Please attach separate resume listing any honors/achievements/community service/extracurricular activities.

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