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North Dakota Horseshoe Pitchers Association

Application For Junior Horseshoe Pitchers Scholarship (Revised 06-2003)

This form must be completed and sent to: Stuart Sipma, 2826 Domino Drive, Bismarck, ND 58503

APPLICATION DEADLINE: June 21st Of Each Year

NAME:____________________________________
(First Name, MI, Last Name)
ADDRESS:___________________________________

TELEPHONE NUMBER:______________________ CITY:_____________________ZIP CODE:__________

BIRTH DATE: MONTH:_________ DAY:_________ YEAR:_________
GRADE IN SCHOOL:_________
LIST ANY AWARDS, ACHIEVEMENTS, OR COMMUNITY SERVICE ACTIVITIES:____________________
PARENT OR GUARDIAN'S NAME:__________________________________________
ELIGIBILITY: A youngster must have just completed any of Grades 7 through 12 and have been a Junior member of the NHPA during the pitching season prior to the last school year and have met the
pitching requirements set by the Junior Scholar Horseshoe Pitchers Awards Program.

The applicant must have a grade average of no less than a B- for the entire school term.

A complete up-to-date transcript must be furnished with this application.
If a scholarship is awarded, the funds will be kept by the North Dakota Horseshoe Pitchers Association for the applicant and will NOT accrue interest during this period.
When the applicant is accepted by an accredited college or university, a notice of the acceptance should be forwarded to the Junior Promotion Director, at which time the funds will be released to the applicant.
In the event that the applicant does not pursue higher education within one year of graduation from high school, the funds will revert back to the NDHPA. THE PARENT(S) OR GUARDIAN(S) MAY BE REQUIRED TO VERIFY THE APPLICANT'S AGE.
I UNDERSTAND AND HAVE READ THE ABOVE ELIGIBILITY REQUIREMENTS.
SIGNED BY APPLICANT:_______________________________________ DATE:____________________

PARENT(S) OR GUARDIAN(S) CERTIFICATION:
WE UNDERSTAND THAT THE FUNDS WILL NOT BE TRANSFERRED TO THE APPLICANT IF FURTHER EDUCATION IS NOT PURSUED AFTER GRADUATION FROM HIGH SCHOOL.

SIGNED BY PARENT OR GUARDIAN: ___________________________________________ _______________________________________(DATE) _______________________

THE ABOVE APPLICATION HAS BEEN APPROVED AND ACCEPTED FOR AWARD CONSIDERATION:
SIGNED:_____________________________________(DATE) _______________________
STUART SIPMA
NDHPA JUNIOR PROMOTION DIRECTOR