Amateur Radio Education Fund of Southwest Wisconsin

Scholarship Application Form

(Please print or type)

Name _______________________________________________________________________                                      LAST                                     INITIAL                                  FIRST                                                                      

Address _________________________________________________________________ 

 _________________________________________________________________________            CIY                                                                      STATE                                                     ZIP CODE

E-Mail _________________ Call Sign ________________ License Class ____________

School you will attend ______________________________________________________

Location __________________________________________________________________

Have you been accepted _____________________________________________________

Graduated from _________________________________ Date _____________________

GPA ______________________ Advisor ________________________________________

On a separate page please list the following:

Your Amateur Radio activities and Interests:

School activities:

Community activities:

Attach a short composition that states “Why I think I deserve this scholarship”.

Signature ____________________________________ Date ______________ 20_____

Submit completed form to Ed Toal, W8471 State Road 39, Blanchardville, WI  53516 or ed@n9mw.com. 

NOTE: We may request additional information or conduct interviews in order to further qualify applicants.