2013 Maoteen - State Application for Disbursement of CMNH Funds

Application for Disbursement of CMN Scholarship Funds

Completion of this form and the attachment of the necessary documentation are required for the payment of all scholarships. No exceptions will be made without the consent of the MAOTeen Scholarship Committee. No forms will be accepted via email or fax without the prior consent of the MAOTeen Scholarship Chairman.

DATE OF APPLICATION______DATE OF HS GRADUATION______

CONTESTANT NAME______

NAME OF STATE TITLE AND YEAR______

ADDRESS______

PHONES & EMAIL______(HOME) (CELL) (EMAIL ADDRESS)

PARENTS’ NAMES______

PARENTS’ ADDRESS______

PHONES & EMAIL______(HOME) (CELL) (EMAIL ADDRESS)

NAME OF AWARD______

AMOUNT AWARDED____* $500 increments only______

PLEASE PAY CLOSE ATTENTION TO THE FOLLOWING INFORMATION:

• PRIOR TO AWARDING THESE FUNDS, PLEASE SEEK PRIOR WRITTEN APPROVAL FROM THE MAOTEEN OFFICE WITHIN 30 DAYS BEFORE THE PAGEANT.

• YOU MUST SUBMIT THIS FORM WITHIN 30 DAYS AFTER YOUR PAGEANT IF AWARD IS PRESENTED.

• IN ORDER FOR CONTESTANT TO REDEEM THIS SCHOLARSHIP, SHE WILL NEED TO SUBMIT THE APPLICATION FOR SCHOLARSHIP DISBURSEMENT OF MAOTEEN FUNDS FORM UPON GRADUATION. NORMAL SCHOLARSHIP RULES APPLY.

01828ed2e698a2cffb793096a959fa5f.doc Application for Disbursement of CMNH Scholarship Funds - Page 2

IT IS IMPORTANT THAT YOU REVIEW ATTACHMENT B OF THE NATIONAL CONTRACT FOR COMPLETE RULES AND REGULATIONS REGARDING THE PAYMENT OF SCHOLARSHIP FUNDS.

I HAVE READ THIS DOCUMENT AND ATTACHMENT B OF THE CONTRACT. I UNDERSTAND THAT I MUST FOLLOW THESE INSTRUCTIONS AND THE RULES AND REGULATIONS FOUND IN THE NATIONAL CONTRACT REGARDING THE DISBURSEMENT OF ALL SCHOLARSHIPS. I ALSO AGREE THAT ANY DISPUTE THAT MAY ARISE CONCERNING THE PAYMENT OF SCHOLARSHIPS WILL BE REVIEWED BY THE SCHOLARSHIP COMMITTEE AND THEIR RESOLUTION SHALL BE THE FINAL WORD OF THE MAOTEEN ORGANIZATION.

______SIGNATURE OF CONTESTANT SIGNATURE OF PARENT OR GUARDIAN

______DATE DATE

INSTRUCTIONS:

 MAKE COPIES, FOR YOUR FILES, OF ALL THE DOCUMENTS YOU ARE SENDING.  SEND ALL DOCUMENTATION VIA REGISTERED MAIL, FEDEX, OR SOME OTHER TRACEABLE MEANS.  SEND THIS FORM WITH ALL REQUIRED ORIGINAL DOCUMENTATION TO:

MAOTeen SCHOLARSHIP COMMITTEE 4700 140TH AVE N SUITE 101 CLEARWATER, FL 33762

Miss America’s Outstanding Teen, Inc. is a 501(c)(3) tax-exempt organization

01828ed2e698a2cffb793096a959fa5f.doc