North Dakota Horseshoe Pitchers Association
Application For Junior Horseshoe Pitchers Scholarship
(Revised 06-2003)
This form must be completed and sent to:
Stuart Sipma, 2826 Domino Drive, Bismarck, ND 58503
APPLICATION DEADLINE:
June 21st Of Each Year
NAME:____________________________________
ADDRESS:___________________________________
(First Name, MI, Last Name)
TELEPHONE NUMBER:______________________ CITY:_____________________ZIP
CODE:__________
BIRTH DATE: MONTH:_________ DAY:_________ YEAR:_________ GRADE IN
SCHOOL:_________
LIST ANY AWARDS, ACHIEVEMENTS, OR COMMUNITY SERVICE
ACTIVITIES:____________________
PARENT OR GUARDIAN’S
NAME:___________________________________________________________
ELIGIBILITY: A youngster must have just completed any of Grades 7 through 12 and have been a
Junior member of the NHPA during the pitching season prior to the last school year and have met
the pitching requirements set by the Junior Scholar Horseshoe Pitchers Awards Program. The
applicant must have a grade average of no less than a B- for the entire school term. A complete up-
to-date transcript must be furnished with this application.
If a scholarship is awarded, the funds will be kept by the North Dakota Horseshoe Pitchers
Association for the applicant and will NOT accrue interest during this period. When the applicant is
accepted by an accredited college or university, a notice of the acceptance should be forwarded to
the Junior Promotion Director at which time the funds will be released to the applicant. In the event
that the applicant does not pursue higher education within one year of graduation from high school,
the funds will revert back to the NDHPA.
THE PARENT(S) OR GUARDIAN(S) MAY BE REQUIRED TO VERIFY THE APPLICANT’S AGE.
I UNDERSTAND AND HAVE READ THE ABOVE ELIGIBILITY REQUIREMENTS.
SIGNED BY APPLICANT:_______________________________________
DATE:____________________
PARENT(S) OR GUARDIAN(S) CERTIFICATION:
WE HAVE READ AND UNDERSTAND THE ABOVE REQUIREMENTS. WE UNDERSTAND THAT THE
FUNDS WILL NOT BE TRANSFERRED TO THE APPLICANT IF FURTHER EDUCATION IS NOT
PURSUED AFTER GRADUATION FROM HIGH SCHOOL.
SIGNED BY PARENT OR GUARDIAN:
___________________________________________
_______________________________________
___________________________________________
_______________________________________
(DATE) (DATE)
THE ABOVE APPLICATION HAS BEEN APPROVED AND ACCEPTED FOR AWARD CONSIDERATION:
SIGNED:___________________________________
________________________________________
STUART SIPMA (DATE)
NDHPA JUNIOR PROMOTION DIRECTOR
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