<p> Application for Disbursement of CMN Scholarship Funds</p><p>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. </p><p>DATE OF APPLICATION______DATE OF HS GRADUATION______</p><p>CONTESTANT NAME______</p><p>NAME OF STATE TITLE AND YEAR______</p><p>ADDRESS______</p><p>PHONES & EMAIL______(HOME) (CELL) (EMAIL ADDRESS)</p><p>PARENTS’ NAMES______</p><p>PARENTS’ ADDRESS______</p><p>PHONES & EMAIL______(HOME) (CELL) (EMAIL ADDRESS)</p><p>NAME OF AWARD______</p><p>AMOUNT AWARDED____* $500 increments only______</p><p>PLEASE PAY CLOSE ATTENTION TO THE FOLLOWING INFORMATION:</p><p>• PRIOR TO AWARDING THESE FUNDS, PLEASE SEEK PRIOR WRITTEN APPROVAL FROM THE MAOTEEN OFFICE WITHIN 30 DAYS BEFORE THE PAGEANT.</p><p>• YOU MUST SUBMIT THIS FORM WITHIN 30 DAYS AFTER YOUR PAGEANT IF AWARD IS PRESENTED.</p><p>• 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.</p><p>01828ed2e698a2cffb793096a959fa5f.doc Application for Disbursement of CMNH Scholarship Funds - Page 2</p><p>IT IS IMPORTANT THAT YOU REVIEW ATTACHMENT B OF THE NATIONAL CONTRACT FOR COMPLETE RULES AND REGULATIONS REGARDING THE PAYMENT OF SCHOLARSHIP FUNDS.</p><p>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.</p><p>______SIGNATURE OF CONTESTANT SIGNATURE OF PARENT OR GUARDIAN</p><p>______DATE DATE</p><p>INSTRUCTIONS: </p><p> 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:</p><p>MAOTeen SCHOLARSHIP COMMITTEE 4700 140TH AVE N SUITE 101 CLEARWATER, FL 33762</p><p> Miss America’s Outstanding Teen Organization - All rights reserved </p><p>Miss America’s Outstanding Teen, Inc. is a 501(c)(3) tax-exempt organization</p><p>01828ed2e698a2cffb793096a959fa5f.doc</p>