Soroptimist International of Sedona

Jan French Kavet Scholarship Program

Application Form

Applicant Name: ________________________________________________________________

Address: _________________________________________________________

Telephone: ________________________________________________________

Are you the head of household with primary financial responsibility for yourself and/or dependents?: ______________________________________________________

Name of School Attending: _____________________________________________

Medical Skill/Subject/Degree pursuing: ____________________________________

Anticipated year of completion: __________________________________________

Why did you choose this field of study? _____________________________________

What do you like most about this field of study? _______________________________

What do you like least about this field of study? _______________________________

After you complete your education what do you plan to do with your skills? ____________

________________________________________________________________

In your own words tell us why you deserve this award: __________________________

Please provide 3 references (forms must be completed). Applications must be postmarked not later than December 15, 2007. Scholarship monies will be awarded January 9, 2007 at the Monthly Business Meeting of Soroptimist International of Sedona.

Applicant Signature: _________________________________________________

Date: _______________________________

Return this completed application to Soroptimist International of Sedona, Attn: Kathy Nelms, P.O. Box 1105, Sedona, AZ 86339