The Kamehameha Schools Alumni Association
Intermountain Region
Scholarship Application Form

Explorations 2003




Name of Applicant:

_________________________________________________________________________________
Last Name First Name


Home Address:

_________________________________________________________________________________
Street Address Apt. No.


_________________________________________________________________________________
City State Zip


Home Phone (_____)________________ Mobile phone (_____)_________________



Week that Applicant will attend Explorations ___________________________________


Scholarship Amount applying for ($350 Maximum) ______________________________



Signature of Parent/Guardian ________________________________________________


Return by: May 15, 2003


Verification of Registration for Explorations is required.
Please enclose copy of registration confirmation with this application.

Send to:

        Ron Yasukawa
    1351 Swinton Lane
    Farmington, Utah 84025
    Email: [email protected]
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