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Please fill out all items in full, typing or printing legibly in ink. Your signature is

required on page two. Use additional sheets if necessary.

Aviatrix Any-Certificate or Rating Scholarship

Aviatrix Advanced Cert/Rating Scholarship

Email Address ___________________________________________

Date of solo sign-off, if any: ______________________

Written test passed: Y / N Date: ________________________

Ratings, if any: ________________________________________________________________

Airman certificate number, if any; ________________________________________________

Medical class and expiration date, if any: __________________________________________

Date of most recent flight review, if any: ___________________________________________

Total flight time: ______________________ PIC: ___________________________

Education level achieved: ________________________________________________________

Other related aviation education, if any: ___________________________________________

Rating(s) sought: _______________________________________________________________

Current Flight School and/or Instructor Name & Number:____________________________

______________________________________________________________________________

Professional or aviation organizations of which you are a member: _____________________

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1. The scholarships will be paid directly to the flight school and/or independent

flight instructor conducting the training. Receipts showing hours flown and

signed by both student and instructor must be submitted before funds are

dispersed.

2. Recipient agrees to complete the certificate/rating within one (1) year of receipt of

scholarship award. If the recipient does not complete the certificate/rating

appropriate to the award within one year of the award date, the recipient’s status

will be reviewed. Special circumstances will be considered. Copies of the

Logbook should be provided monthly along with a report from the instructor.

3. Recipients who successfully complete their ratings will receive a one-year’s

membership in both the Ninety-Nines International Organization of Women Pilots

main organization and the Rio Colorado chapter.

4. Any unused monies will revert to the Rio Colorado Ninety-Nines Scholarship

Fund.

5. Only one scholarship will be awarded per rating or certificate per person. (Upon

the chapter’s discretion.)

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Neither the Rio Colorado chapter of the Ninety-Nines, Inc., the Southwest Section of the Ninety-Nines,

Inc., nor the Ninety-Nines, Inc., nor their members, agents or representatives are responsible for the

quality of any training received with this scholarship, nor for any accident, incident, or any other event

which may occur while the recipient of this scholarship is performing flight training, or activities

related thereto. Recipient agrees to sign his Hold Harmless Agreement in favor of said entities upon

receipt of the scholarship and before any flight is made.

I hereby release the Ninety-Nines and any of its affiliated organizations from all actions, claims or

demands that I, my assignees, heirs, distributes, guardians, and legal representatives now have or may

hereafter have for injury or damage resulting from my participation in any activities related to this

scholarship.

I agree to abide by all the terms and conditions specified on this application. I declare under penalty of

perjury that the information that I have given here is true and correct and that I meet the eligibility

requirements for the scholarship sought.

________________________________________________________ _______________

APPLICANT SIGNATURE DATE

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1. Written exam if applicable.

2. Medical current.

3. Essay about yourself, your goals, why you would like a scholarship, background

about yourself, financial need if applicable.

4. Two letters of recommendation

The Rio Colorado Chapter looks at all aspects of the applicant’s background, goals and

need. The award will be given based on all criteria, so we encourage all to apply.