Indy Cc Scholarship Application

Indy Christmas Conference Scholarship Request Form Due Date: November 30th, 9:30 p.m. (late applications will not be accepted) To Whom: Personally deliver it to Joe Kleibscheidel or Alison Ziemke at Reverb. Cell: 330-472-8936 or 419-656-7941 When Will I Hear: We will respond to all applicants on December 4th by 5:00 p.m. via email. Registration: If the applicant does not in turn apply to IndyCC by noon, Dec. 5th (in order to receive the early registration discount) their scholarship will be cancelled. Register at www.indycc.com. (please write as clearly as possible) Name:________________________ Year: 1 2 3 4 5

Circle One

MU-Dorm _________ MU-off campus

Email:________________________

Phone: ____________________

Have you ever been to IndyCC before?

Y

N If so, how many?___

Why do you want to go to IndyCC this year? What are you hoping to gain from going?

IndyCC is $199 for those who register by Dec. 5th at noon. How much of that $199 could you strive to cover? __________