Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Phone *

(###)

###

####

Expected High School Graduation Date *

MM

DD

YYYY

Are you or your parent(s) members of the UFAA? *

Yes

No

Are you an athletic recruit? *

Yes

No

If you are selected to receive one of the Tampa Gator Club Scholarships, do you consent to having your name and/or photograph published in the club newsletter and on the club website? *

Yes

No

If you are selected to receive one of the Tampa Gator Club Scholarships, you commit to being in attendance to the Scholarship Banquet on June 13th at 6:00pm at The Tampa Club t in Downtown Tampa. Failure to attend will result in scholarship being revoked. *

Yes

No

I agree that I must be commited to UF to be eligible for a scholarship *

Agree