2017 scholarship entry form

Nomination Form

Nominee: ________________________________________________________

Address: ________________________________________________________
(street, city, state, ZIP)

Email: ________________________________________________________

High school: _______________________________________________________

Address: ________________________________________________________

Nomination submitted by: ____________________________________________________

Title: ________________________________________________________

Telephone number (day): ___________________________________________________

Email: ________________________________________________________________

List all materials submitted with this entry:

________________________________________________________

________________________________________________________

________________________________________________________
How did you learn about this opportunity? ________________________________________

Send entries to:
Northern Illinois Newspaper Association
c/o John Etheredge
Record Newspapers
109 W. Veterans Parkway
Yorkville, IL 60560
Deadline extended: April 14, 2017