Please fill out all items in full, typing or printing legibly in
ink. Use additional sheets if necessary.
Name_________________________________________ Date of Birth
_________________
Address _______________________________________
Telephone:____________________________________ work
________________
______________________________________________ home
________________
Date of solo sign-off, if any: _______________________
Written test passed: ______________________________ Date:
_______________________
Ratings, if any:
__________________________________________________________________
Airman certificate number, if any:
___________________________________________________
Medical class and expiration date, if any:
_____________________________________________
Date of most recent flight review, if any:
_____________________________________________
Total flight time: ________________________________ PIC:
________________________
Education level achieved:
__________________________________________________________
Other related aviation education, if any:
______________________________________________
Rating(s) sought:
________________________________________________________________
Professional or aviation organizations of which you are a
member:___________________________
_______________________________________________________________________________
Additional documentation required
Personal essay. In no more than 500 words, address the
following topics: your personal interests, general goals, career
goals, and aviation goals; any special qualifications you may
have to pursue these goals; what sparked your initial interest
in aviation; what aviation-related activities you have
participated in (including employment) that mean the most to
you; how this scholarship will help you achieve your goals; any
obstacles you have had to overcome to start in and continue in
flying; and how you would contribute to the Ninety-Nines and to
the aviation community in general.
Budget Information. Please provide a budget of anticipated
expenses for the rating sought, anticipated funding to meet
these expenses, and indicating whether you own or intend to rent
an aircraft. The budget submitted should be signed by the flight
school or independent instructor you plan to use to obtain the
rating. The list of funds should include any other anticipated
financial aid. If there are any special circumstances regarding
your financial need, briefly list them.
Letters of Recommendation. Submit no more than three; at
least two must be from persons knowledgeable about your interest
or accomplishments in aviation.
Neither the Mount Shasta chapter of the Ninety-Nines Organization
of Women Pilots, Inc., the Southwest Section of the Ninety-Nines
International Organization of Women Pilots Inc., nor the Ninety-Nines
International Organization of Women Pilots Inc., nor their members,
agents, or representatives are responsible for the quality of any
training received with this scholarship, nor for any accident, incident,
or any other event which may occur while the recipient of this
scholarship is performing flight training, or activities related
thereto; and recipient agrees to sign a hold-harmless agreement in favor
of said entities upon receipt of the scholarship and before any flight
training is made. I hereby release the Ninety-Nines and any of its
affiliated organizations from all actions, claims or demands that I, my
assignees, heirs, distributes, guardians, and legal representatives now
have or may hereafter have for injury or damage resulting from my
participation in any activities related to this scholarship.
I agree to abide by all the terms and conditions specified on this
application. I declare under penalty of perjury that all the information
I have given here is true and correct and that I meet the eligibility
requirement for the scholarship sought.
Signature _________________________________________
Date__________________________
Application deadline is December 31