Annie Epting Scholarship

Thank you for taking the time to apply for the Annie Epting Scholarship! To ensure we have all the information needed for evaluation, please complete this application in full.

Submissions must be completed by March 25th, 2022.





Name of College or University you plan to attend:
Family/Household Information




Extracurricular Activity Information




Applicant's Final Thoughts


Academics






ASSIGNMENT OF RIGHTS & CONSENT TO PUBLISH SCHOLARSHIP INFORMATION
KNOW ALL PERSONS BY THESE PRESENTS:
That I,
do hereby give The Greater Chapin  Chamber of Commerce full rights to publish my name, where I live (city and state only; actual street addresses and phone number WILL NOT be disclosed), my pertinent family information (financial information WILL NOT be disclosed), college I am attending, and any photographs that may be taken upon presentation of scholarship if I am chosen as the recipient.
I understand that by execution of this agreement, I am relinquishing my rights to any future compensation for reproduction, publication or use of the above information by The Greater Chapin Chamber of Commerce in its print or electronic correspondence, on its website or social media websites.
I understand that this Agreement in no way obligates The Greater Chapin Chamber of Commerce to publish or use the above-described information.


The parties agree that this Agreement may be executed and delivered by electronic signatures and that the typed signatures appearing above are the same as handwritten signatures for the purposes of validity, enforceability and admissibility.