@
Trinity
2010 - 2011
Scholarship Application Form
With growing family needs, many
MOPS moms find themselves adjusting to new lifestyles and
financial situations. Because we want to include anyone who
wishes to join, and believe that all requests for
assistance be honored on a true need, we offer a limited
number of scholarships and partial scholarships.
Name: _____________________________________________________
Phone: ________________________________
I am requesting a scholarship in the form of the following:
_____ Monthly Dues ($5 per mtg x’s 9 mtgs = $45
total)
_____ Partial Payment of Monthly Dues
_____ Payment to MOPS International ($23.95 annual fee)
_____ Half scholarship to MOPS International ($12 towards
annual fee)
We ask that you keep the scholarship and the amount
received confidential.
Signed: ________________________________________________
Date: _________________________
Please return this form with your registration form to the
Coordinator or Finance Coordinator as soon as possible.
Please know that any information on this application will
be held in the strictest of confidence.
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For Finance Coordinator Use Only:
Amount awarded:
________ Date awarded: ______ Database entry: _______