Indiana AHPERD Catherine wolf conference scholarship recipient form

Directions: The College Coordinator should complete the Recipient Form for the ONE student selected to receive the Catherine Wolf Conference Scholarship. The form should be mailed to the following address so that it is received no later than October 1: Karen Hatch Executive Director / Marketing Coordinator 2007 Wilno Drive Marion, In 46952 765.664.8319 hatch@comteck.com The student whose name appears on this form will receive a Catherine Wolf Conference Scholarship. When he/she arrives at the conference, he/she should go to the registration table to pick up registration materials and a ticket for the Council for Future Professionals Pizza Party. If the student will not be attending the conference, please notify us no later than November 1. Scholarship recipients will be introduced at the Council for Future Professionals Pizza Party. They will also receive a certificate that identifies them as receiving the Catherine Wolf Conference Scholarship. College/University Student's Name Student's Street Address City,State,Zip Student's Email Student's Phone Print Name of College Coordinator Signature of College Coordinator