@
Trinity
2008 - 2009
Scholarship
Application Form
With
growing family needs, many MOPS moms find themselves
adjusting to new lifestyles and financial situations.
Because we want to include anyone who wishes to join, and
believe that all requests for assistance be honored on a
true need, we offer a limited number of scholarships and
partial scholarships.
Name: _____________________________________________________
Phone: ________________________________
I am requesting a scholarship in the form of the following:
_____ Monthly Dues ($5 per mtg x’s 9 mtgs = $45
total)
_____ Partial Payment of Monthly Dues
_____ Payment to MOPS International ($23.95 annual fee)
_____ Half scholarship to MOPS International ($12 towards
annual fee)
We ask that you keep the scholarship and the amount
received confidential.
Signed: ________________________________________________
Date: _________________________
Please return this form with your registration form to the
Coordinator or Finance Coordinator as soon as possible.
Please know that any information on this application will
be held in the strictest of confidence.
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For Finance Coordinator Use Only:
Amount
awarded: ________ Date awarded: ______ Database entry:
_______