Name _______________________Date _

Address _________________________________________

____________________________________ Telephone ________________

Birth Date ____________ Occupation _________________________________

Educational Background __________________________________________________

_____________________________________________________________________________________

Name of current instructor and /or flight school

__________________________________________________________________

Date and Place of First Solo _______________________________________________

If under the age of 18, give parent’s name and address

_____________________________________________________________________________________

Reason for seeking scholarship.

_____________________________________________________________________________________

I attest the above statements are true to the best of my knowledge and that I shall use any funds granted me to further my aviation training.

Signed ___________________________

Signature of Parent (If under 18) ______________________________________

(Please complete CFI recommendation on other side)

I, _________________________________________ CFI, do hereby recommend

____________________________________________________________

for the Vermont Chapter 613 Experimental Aircraft Association Edmando Roberti Scholarship Award. The reasons that I recommend this person are the following:

______________________________________________________________________________

I hereby certify that the above is a true statement, to the best of my knowledge.

Date _________________

Signed _________________________ CFI# ______________

Address _____________________________________________________________

___________________________________ Telephone __________________

Name _______________________________________Date _________________

Name _______________________Date _