American Glass Guild
James C. Whitney Memorial Scholarship
- Application -
Sponsored by the American Glass Guild, Inc.
www.americanglassguild.org
For a PDF of this application click here.
NAME: _________________________ DATE: ______________________
ADDRESS: __________________________________________________
CITY: ________________________ STATE: ________ ZIP: ___________
PHONE: ____________________ EMAIL: __________________________
NAME OF CLASS, WORKSHOP, ETC.:
_____________________________________________________
_____________________________________________________
INSTRUCTOR’S NAME: _____________________________________
INSTRUCTOR/SCHOOL PHONE: __________________________
INSTRUCTOR/SCHOOL EMAIL _________________________________
INSTRUCTOR/SCHOOL ADDRESS (Check will be mailed to this address):
_____________________________________________________________
_____________________________________________________________
INCLUSIVE DATES OF CLASS:
________________________________________________
TOTAL FEE FOR CLASS: $ _______________