Please print the form, and follow directions on Summer Scholarship Conditions and Rules Last Name: _____________________________________ First Name: _____________________________________ Number, Street Address:_____________________________________ City, State, Zip: ___________________ ___ ______ Telephone: ______ - ______ - __________ Email: _____________________________________ Date and place of birth: _________________________________________________________________ Student must be 18 years old at the time the program begins High School Name and Address: __________________________________________________________________ __________________________________________________________________ Grade ____ French Teacher's name: ____________________________________________ Do you have a valid U.S. passport for travel abroad? Yes _____ No _____ Have you ever traveled abroad? Yes _____ No _____ If yes: Where? When? Purpose? Length of stay? ______________________________________________________________ _______________________________________________________________ ________________________________________________________________ Recommended by (Name) _______________________________________________________________ Recommended by (Name) _______________________________________________________________ Please submit each recommendation with your application in a separately sealed envelope. Signature of Candidate Date _____________________ _____________________ Signature of Parent or Guardian Date __________________________ _________________________ Merci!
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