Pacific Northwest Koi Clubs Association

PNKCA Scholarship Application
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To apply for a Scholarship, please fill in the form below. If you have any problems with the form you can send an email instead to dneg001@gmail.com:

Date
Name
Street Address
City
State
Zip Code
E-Mail
Program Choice
Club Affiliation Name
Club Contact Name
Club Contact Phone
Club Contact E-Mail
Electronic SignatureBy submitting the form, I affirm that the facts set forth in it are true and complete. I understand that the scholarship criteria is set forth by the applicant's home club and disbursement of the $100.00 application fee is done by the applicant's home club
Print Name
  

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age or disabilitiy.