Midwest Writing Center                SCHOLARSHIP APPLICATION

Mail to:

Spring Residency Scholarship Application      

 Midwest Writing Center

225 E. 2^nd St.  Suite 303

Davenport, IA 52801

Phone:  563-324-1410

Scholarship requests:

§        Submitted no later than February 20, 2008 for spring residency

§        Completed by child’s parent and returned with the Workshop Registration form

§        You will be notified of any award before February 29, 2008.

Father’s Name_________________________________ Mother’s Name______________________________

Home Address ______________________________ City __________________ State ________ Zip______

Home Phone _____________________________________  Business Phone _________________________

Name of Child _____________________________________    Age _______

Information below must be completed in full to be considered.

Total Gross Yearly Household Income Level $ _______________ Total number of children at home _______

Please give a detailed outline of your “financial reasons” of why you need the scholarship. (Information is kept strictly confidential)                                                  

(Continue on reverse side for additional space)

For Office Use Only

Scholarship: Denied___________ Granted __________