TAB A
Application for the A. Scott Crossfield Memorial
Youth Activities Endowment
For an Individual
DATE: _________________________
NAME: __________________________________________________________________________
ADDRESS: _______________________________________________________________________
_______________________________________________________________________
PHONE NO.: _______________________ EMAIL: _____________________________________
PARENT’S/GUARDIAN’S INFORMATION (for applicants under eighteen years of age):
NAME: ____________________________________________________________________
SIGNATURE: ______________________________________________________________
ADDRESS/PHONE/EMAIL (if different from applicant’s): __________________________
____________________________________________________________________________
____________________________________________________________________________
IDENTIFY SPECIFIC USE (Air Academy, Private Pilot Grant, College Scholarship, etc.):
NAME AND ADDRESS OF ACTIVITY TO BE ATTENDED (if endowment to be used for this purpose):
PLEASE ATTACH TO THIS APPLICATION A DETAILED EXPLANATION OF YOUR AVIATION-RELATED EXPERIENCES, INTERESTS AND CAREER GOALS (NOTE: This information must be provided for the application to be considered.)
SIGNATURE OF APPLICANT: ________________________________________________________
DECISION BY THE BOARD OF DIRECTORS: _____ APPROVED _____ DENIED
_______________________________________________ ___________________________________
EAA CHAPTER 186’s SECRETARY’S SIGNATURE DATE