|
IDAHO ENLISTED ASSOCIATION
Applicant’s Name:________________________________________________________
Last First MI
Address:________________________________________________________________
City:____________ State:___________ Zip:_______________
Telephone:___________________ Age:________ Birth date:_________________
Social Security #:_____________________________ Sex:__________________
Current Status High School____________ Post- Secondary___________________
Student activities applicant has participated in: ________________________________________________________________________________________________________________________________________________________________________________________________________________________
Offices/ positions applicant has held on any organization: ________________________________________________________________________________________________________________________________________________________________________________________________________________________
Honors (scholastic, citizenship etc.) awarded to applicant: ________________________________________________________________________________________________________________________________________________________________________________________________________________________
Institution applicant will attend: _____________________________________________
Scholarships and amount received by applicant to date: ___________________________
Scholarships applied for to date: _____________________________________________
Sponsor Information
Rank/ Name _____________________________________________________________
Last First MI
Address: ________________________________________________________________
City:_____________________ State: _______________ Zip: __________________
Phone # Home (_____) _______-_________ Work (_____) _______-_________
Place of employment: _____________________________________________________
Number of dependent children in sponsor’s family to include applicant:______________
Pre-School:_______ Elementary:_______ High School:_________ College:__________
Total family income: Below $20,000/yr __________
$20,000 to $40,000/yr _______
$40,000 to $60,000/yr _______
Above $60,000/yr__________
This application has been completed to the best of my knowledge and belief:
____________________________ ___________________________________
Applicant Signature Sponsor’s Signature
Date: ________ Membership number: ___________ Membership exp. date: __________
Submit with all required attachments to:
Chris Brearley
1501 Shoshone St
Boise, Id 83705
|