2020 I AM A GIRL LEADERSHIP SCHOLARSHIP

The Hills Basketball Association (HBA) I am a GIRL Leadership Program will incorporate female players, referees, coaches, referee coaches, officials & media presenters and will focus on developing both their technical skills as well as their leadership skills.

Applicant's Name Applicant's Name First Last
Date of Birth Date of Birth / DD / MM YYYY
Current Age:
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Mobile Phone
Email
Emergency Contact
Phone Number:
I would like to apply for the following scholarship:
Background/Experience of applicant:
How will this scholarship benefit you?
DECLARATION

I declare that, to the best of my knowledge and belief, all the information I have provided above is true and correct.

I give permission for my video submissions to be used in any IAAG promotional material Hills Basketball Association may require throughout 2020 & 2021.
Applicant's Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / DD / MM YYYY
If under 18 years of age, approval from parent/guardian to apply is required.
Parent's Name Parent's Name First Last
Parent's Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / DD / MM YYYY

2020 I AM A GIRL LEADERSHIP SCHOLARSHIP

2020 I AM A GIRL LEADERSHIP SCHOLARSHIP

DECLARATION

If under 18 years of age, approval from parent/guardian to apply is required.