YSSP Scholarship Payout Request Form – North Caddo Shooting Club

Participant Name *

First

Last

Phone *

Email *

Details on College or Program Attending *

Amount Requested *

Name To Make Check Out To *

If other than an accredited college, please upload any documentation on the program. If payment is reimbursement to an individual, please upload a copy of the paid receipt or invoice for the program.

Please Upload Program Details, If Not an Accredited College

Drag & Drop Files, Choose Files to Upload

Please Upload a Copy of any Receipts

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Address to Send Check To *

Address Line 1

City

State

Zip Code

Signature of Participant or Parent/Guardian (If participant is under 18 years of age) *

Clear Signature