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Scholarship Application

* indicates a required answer.

If you are in need of a scholarship for membership to CHESS, please fill out and submit the following information.

1. * First Name
2. * Last Name
3. * E-mail Address
4. * Confirm E-mail Address
5. Telephone Number (OPTIONAL)
6. *

Briefly describe your financial situation.

7.

Are you able to pay anything toward your membership at this time?

Yes No
8.

If yes, how much are you able to give?

9.

Have you received a scholarship from CHESS before?

Yes No
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