Voice Solutions -The Voice Solutions Scholarship Fund Application

Voice Solutions Scholarship Fund for People with Disabilities

- Application -

Date:
Title (check one)	Mr. Mrs. Ms.
Name:
Date of Birth:
Address:
City:	State: Zip:
Phone:
Proposed Occupation:	Major:
School Name:	Location:

Next Fall I Plan to: Attend Not attend college Transfer to a 4 yr. college
LIST ANY OTHER COLLEGES ATTENDED
Name of College	Dates of Attendance/Degree

Pursuant to the Family Education Right and Privacy Act of 1974 (P.L. 93.380), I hereby give approval for my name and/or picture to be published by a magazine or newspaper
Yes No

Signature _______________________________________

After you have completed the entire form, Print it out and deliver along with all pertinent documents to:

8 Snapdragon
Irvine, CA 92604
(949) 653-7005 ph.
(949) 653-7070 fax