USTA/MS CAMP SCHOLARSHIP APPLICATION/RECOMMENDATION FORM

Applicant's Name________________________________________________________________

Address:__________________________City:___________________State:_____Zip:_________

Home Phone:(____)_________________DOB:_____________Age:____USTA#:____________

Parent or guardian's name:______________________________Work #:(____)_______________

Program applicant has or is presently participating in:___________________________________

E-mail:__________________________________ Fax:__________________________________

Recommender's name:________________________Phone #:(____)_________________________

 ****  Please complete all of the following before submitting the application.  ****

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Have one letter of recommendation written by an individual who is familiar with the child's character and tennis interest.  Have the child write a letter of interest, including their tennis goals for the summer.

 Is the child currently a member of the USTA?                                                       Yes (  )   No  (   )

                 ** If not, please enroll by phone or the web!

                 Call 1-800-990-8782 or go to http://www.usta.com

 Does the child currently hold a USTA/MS District ranking?                                 Yes (  )   No  (  )

 Has the child ever received a USTA/MS Camp Scholarship?                               Yes (  )   No  (  )

 Without financial assistance, would the child be able to attend a tennis camp?       Yes  (  )  No  (  )

 Would the child be able to stay overnight at a camp where housing is available?    Yes  (  )  No  (  )

 Would the child have transportation and be able to commute daily to a camp

 located within a 45-minute drive of the child's home?                                            Yes  (  )  No  (  )

 ______________________________________________________________________________

Please indicate area/location/district where child would be interested in receiving the scholarship.

 Area___________Location_____________AMD___CPD___DD___EPD___NJD___PATD___

 Please return to:  USTA/MS Camp Scholarships
                            1288 Valley Forge Road, Suite 74, P.O. Box 987,
                            Valley Forge, PA 19482
                           (610) 935-5000 X 239 -  Fax (610) 935-5484

Deadline:   April 29, 2005           

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