MISS FLORIDA SCHOLARSHIP PAGEANT, INC

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					                      MISS FLORIDA SCHOLARSHIP PAGEANT, INC.
                              Scholarship Recap – Local Pageant
                                     DUE: May 19, 2012
                    BRING THIS FORM TO ORIENTATION & TURN IN TO
                           Carole Holsonback, Scholarship Chairman



LOCAL PAGEANT __________________________________ Year ____________________

Date of Pageant: ____________________________ Date of Report ____________________

Total Cash Scholarship Awarded _____________________________ (Current Year)

RECIPIENTS             (Current Year)
Name                          Amount Awarded                  Amount Dispersed

__________________________ _ ________________                 __________________________

__________________________ _ ________________                 __________________________

__________________________ _ ________________                 __________________________

__________________________ _ ________________                 __________________________

__________________________ _ ________________                 __________________________

       TOTALS:                    _________________           __________________

RECIPIENTS:            (Prior Years – Use additional sheet if necessary)
Name                                  Amount Awarded                 Amount Dispersed

___________________________           _________________              ___________________

___________________________           _________________              ___________________

___________________________           _________________              ___________________

       TOTALS:                        _________________              ___________________

SPECIAL SCHOLARSHIP ACCOUNT:

Name of Bank: ________________________________________________________________

Address: _________________________________City ________ State______ Zip_________

Account Number: ________________________ Current Balance $ ____________________
****Important: Please attach a copy of the last bank statement. Universities, Chambers of Commerce, Fair
Organizations, should submit letter of guarantee of an account number and bank balance for scholarship
account. Questions: Please contact Carole Holsonback, cholsonback@tampabay.rr.com; 727-459-9684.

				
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