EAA Vermont Chapter 613

Mary Jane McGrath Scholarship

Application for Aviation Scholarship

(TEXT VERSION0

Name ___________________________________________ Date ________

Address _____________________________________________________

Telephone __________________

Education ______________________________________________________

_______________________________________________________________

_______________________________________________________________

Birthdate _____/____/_____ Date / Class of Last FAA Medical ___/___/___

Airman Certificate Number _______________ Date of Last BFR _________

Current flight school and instructor __________________________________

Current ratings: Please list instructor(s), flight school and date earned.

Private _________________________________ Date _________________

Instrument ______________________________ Date _________________

Commercial _____________________________ Date _________________

Other __________________________________ Date _________________

Hours Actual Instr. Total PIC

SEL _________ ____________ _________

MEL _________ ____________ _________

Other _________ ____________ _________

Written exams passed for Certificates or Ratings not now held ______________

Certificates or Ratings in progress & expected completion date _____________

Present position, employer & date employed

PAGE TWO MCGRATH APPLICATON

Previous employment and dates:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Why are you seeking this scholarship? Use as much space as you require.

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

Signature _____________________________________ Date ___________________________

If under age 18, Parents’ or Guardian’s name, address and signature