The Daughters of the Pioneers of Washington
Walla Walla Chapter No. 12

SCHOLARSHIP APPLICATION

COVER SHEET

NAME ______________________________________________________

ADDRESS ___________________________________________________

___________________________________________________

PHONE NUMBER ______________________

AGE ___________                          NUMBER OF SIBLINGS ____________

SCHOOL NAME _______________________________________________

ADDRESS ___________________________________________________

CLASS NEXT YEAR ____________________________________________

ACADEMIC PURSUIT __________________________________________

NAME – FATHER ______________________________________________

MAIDEN NAME – MOTHER ______________________________________

Applications accepted September 1stthrough May 1stannually

Send applications to:  Judith Fortney, 310 E Chestnut St  Walla Walla WA 99362        509-529-8210