Wild Hearts Adventure Co. Scholarship Request Form

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I, *

Parent/Guardian Name

as of the following date, *

Today's Date

am requesting a scholarship for attendence at Wild Hearts Adventure Co, for my learner(s), *

Learner Name(s)

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for months of

Please list the months of tuition the scholarship would cover

in the amount of *

Total Dollar Amount Requested

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Notes: (ie.Why this scholarship is important to your family, etc.)

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Signature *

Email *