SCI Novi Chapter

Online Scholarship Application Form
“Michigan Wilderness Student Adventure” (MWSA)
Sponsored by SCI-Novi Chapter

Hosted by the Michigan Out-of-Doors Camp for Kids

June 15 – 20, 2008

(Applications will be considered until May 16, 2008,

or until eighty qualified applicants have been approved.)

Please note all fields marked with * are required.

Student's First & Last Name: *
Sex: *	M F
Birth Date: *
Age:*	12 13 14 15
Grade Completed (as of June 2008): *
Home Address: *
City: *
State: *
Postal Code: *
School District & School for 2008 - 2009 Year: *
Email: *
Father's Name: *
Father's Phone #: *
Mother's Name: *
Mother's Phone #: *
Name of Person Nominating Student for this Scholarship: *
What is this person's relationship to the Student: *	Friend Family Teacher Principal Other
Sporting Club of which this person is a Member:	SCI Other:
Has the Student shot a firearm?	Y N
Has the Student shot a bow?	Y N
Has the Student hunted before?	Y N
Please describe how, when and where for the three questions above, and list any animals hunted:
Has the applicant taken a Hunter Safety course? *	Y N
If yes, please describe when and where:
Would the applicant be likely to attend the MWSA program without this scholarship? *	Y N
Has the applicant ever attended a program similar to this before?	Y N
If yes, please describe when and where:

Copy and paste the text of your essay into this space: *
Use this space if needed to complete your essay:

Applicant Information:

You must include a one-page essay on why you should be considered for a scholarship to the Michigan Wilderness Student Adventure (copy and paste it into the last two fields on the submission form above). You are free to expand on the answers to any question in this application along with the reasons why SCI-Novi should consider you as a candidate for this scholarship.

(Applications received without this narrative may not be considered for a scholarship.)

Please use the form above to e-mail your completed application to the program director, Leonard Kruszewski.

(Online applications are preferred.)

You may also print the paper application form and mail it to Leonard:

SCI-Novi Chapter
c/o 27260 Haggerty Rd, Suite A-11

Farmington Hills, MI 48331

The SCI-Novi Education Committee will select up to eighty applicants who qualify as the most deserving to receive a scholarship to the Michigan Wilderness Student Adventure. Anyone who is not chosen for a scholarship is welcome to apply next year or attend the program for the normal cost of $350.00 by contacting Michigan Out-of-Doors Camp for Kids at www.mucc.org.

Once selected, additional applications forms and documents will need to be executed between the student and Michigan Out-of-Doors Camp for Kids.

For more information, you may also email Leonard at mwsa@scinovi.com.

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