Mail to: First Ward Community Fund, Inc. P.O. Box 30712 Charlotte, NC 28230-0712 Fax to: 704.333.9453

Child's Name:
Date of Birth:
Address:
City:
State:
Zip Code:
Parents Name(s):
E-mail Address:
Daytime Phone:
Evening Phone:
Camp or Activity Requested:
Date(s) of Activity Requested:
Cost of Activity:

		Please use this space provided to tell us why your child would benefit from this scholarship.