Form A-2 (FT)

I have given the College Reference Form to each of the following persons:

     ____________________________________________________________________________________
                             Name                        Title                             College or University

     ____________________________________________________________________________________
                             Name                        Title                             College or University

I have given the Personal Reference Form to each of the following persons (relatives are not acceptable):

     ____________________________________________________________________________________
                Name                            Address                                 City                   Zip Code
 

     ____________________________________________________________________________________
                Name                            Address                                 City                   Zip Code

I hereby authorize the CAEYC Tuition Award Committee to obtain from the colleges or universities which I have attended, or from any other source, such additional data as may be required in connection with this application.

I believe that I am qualified to receive the tuition award for which I hereby apply.

I understand that if I receive such an award, I will be required to submit proof of my academic attainments.  I further understand that I must maintain a satisfactory academic standing, in all respects conduct myself in a creditable manner, and continue in the field of Early Childhood Education.  I will keep the committee informed of employment and-or continuing education as requested.

I certify that this application contains only the truth and that it is accurate and complete.

Date:       ______________________

Applicant Name:        ________________________________________________
                                                             Please print

Applicant Signature:   ________________________________________________