EMMA BOOTH KIND AMBASSADOR SCHOLARSHIP FORM Applicant Information Name * First Name Last Name Phone * (###) ### #### Email * Date of Birth * MM DD YYYY High School * High School Graduation Date * MM DD YYYY Parent or Guardian Information Parent/Guardian Name * First Name Last Name Parent/Guardian Phone * (###) ### #### Parent/Guardian Email * Additional Information How many times have you volunteered at Kind Camp? * Please list the total amount of hours you have volunteered with Keys To Kindness outside of Kind Camp (ex. Golf Tournament, Community Events, Internship Program, etc.) * Total Number of Approved Service Hours with other organizations, other than Keys To Kindness. * Academic Achievements and Extracurricular Activities * Community Service History * Required Documents Agreement Consent Agreement * SCHOLARSHIP AGREEMENT FOR ALL SCHOLARSHIPS ADMINISTERED BY KEYS TO KINDNESS. I. Acceptance of Scholarship The scholarship awarded to you through Keys To Kindness has been authorized by the Foundation’s board of directors. The purpose of the award is to help finance tuition, fees, books, and supplies required for study at a tax-exempt institution. Awards used for other than non-taxable expenses must be reported as income on your tax returns, and it is your responsibility to report any tax liability. This Scholarship is subject to your acceptance of the terms described herein. To accept the award and receive the funds authorized, read the terms and if you accept these terms, complete the information requested and check the Consent “I agree to the SCHOLARSHIP AGREEMENT." and then sign. II. Terms: A. All scholarship awards are made in accordance with current and applicable laws and pursuant to the Internal Revenue Service Code and regulations as amended. B. Prior to payment of the scholarship award, the recipient must be accepted and enrolled in a College or Trade School. I agree Thank you!