Love Like Ali Scholarship Application SCHOLARSHIP APPLICATION

Name *

First Name

Last Name

date of birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have You Attended a Windells Session? *

Yes

No

Parent Or Guardian Contact Name *

First Name

Last Name

Parent or guardian phone number *

(###)

###

####

If you are awarded the scholarship will you need help affording the transportation to camp? (This is for planning purposes and does not negatively impact your application) *

No

Yes I would need help with a flight