Primate Freedom Project
PO Box 1623
Fayetteville, Ga. 30214

Application for Scholarship

I am applying for a scholarship for level:  College:  Undergraduate or Graduate
    (please circle one)			       High School:  grades 10-12	
					       Junior High:  grades 7-9	

Name:______________________________________________________________

Mailing Address:______________________________________________________

Phone#1____________________________Phone#2_________________________

E-mail:_____________________________________________________________

Alternate e-mail:_____________________________________________________

Name of school:______________________________________________________

School Address:______________________________________________________

Name of Instructor:___________________________________________________

Number of students in class _____________Instructor's grade for presentation_________

Date of Presentation:________________   Class Subject (ex: Biology)_______________

Instructor's signature:________________________________ Date________________

Applicant agrees to allow Primate Freedom Project to use video on PFP's website to educate others and with full credit for all presentation work and materials to be given to applicant.   

Applicant's signature:_________________________________ Date_____________