Applicant's Name________________________________________________________________
Address:__________________________City:___________________State:_____Zip:_________
Home Phone:(____)_________________DOB:_____________Age:____USTA#:____________
Parent or guardian's name:______________________________Work #:(____)_______________
Program applicant has or is presently participating in:___________________________________
E-mail:__________________________________ Fax:__________________________________
Recommender's name:________________________Phone #:(____)_________________________
**** Please complete all of the following before submitting the application. ****
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Have one letter of recommendation written by an individual who is familiar with the child's character and tennis interest. Have the child write a letter of interest, including their tennis goals for the summer.
Is the child currently a member of the USTA? Yes ( ) No ( )
** If not, please enroll by phone or the web!
Call 1-800-990-8782 or go to www.usta.com
Does the child currently hold a USTA/MS District ranking? Yes ( ) No ( )
Has the child ever received a USTA/MS Camp Scholarship? Yes ( ) No ( )
Without financial assistance, would the child be able to attend a tennis camp? Yes ( ) No ( )
Would the child be able to stay overnight at a camp where housing is available? Yes ( ) No ( )
Would the child have transportation and be able to commute daily to a camp
located within a 45-minute drive of the child's home? Yes ( ) No ( )
______________________________________________________________________________
Please indicate area/location/district where child would be interested in receiving the scholarship.
Area___________Location_____________AMD___CPD___DD___EPD___NJD___PATD___
Please return to: USTA/MS Camp Scholarships
1288 Valley Forge Road, Suite 74, P.O. Box 987, Valley Forge, PA 19482
610-935-5000 x 239 fax 610-935-5484
Deadline: April 29, 2005