Scholarship/Sponsorship Application


I want to provide scholarship monies and/or sponsor children from Samoa to allow them to go to school.

Please provide your contact information:

Name
Street Address
Address (cont.)
Village/City
State/Prov./Island
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Check all that you wish to contribute to:

$75.00 Tuition
$20.00 Fees (testing, books, etc.)
$20.00 Uniforms (2 with slippers)
$10.00 School Kit (bag & supplies)
All of the above
I would like CERF to choose

Total Contribution?


I would like to sponsor (child's name, or eg. 2 boys, etc.)


Parents names


School attending


Village name


What is the best way to contact this/these individuals? (Telephone #, Principal's name and telephone #, Relative's name and telephone #.)



Michelle DeKorver
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Revised: 07/17/06