Colorado Blue Wave Martial Arts Organizational Structure Ideas

							               David Curtis Memorial Scholarship Application Form
                       COBWAMA Tuition Reduction for Financial Need
                    Colorado Blue Wave Martial Arts Mission Statement
We exist to provide quality instruction in the art and science of traditional Tae Kwon Do Chung Do
Kwan to Colorado families and individuals. We provide a fun atmosphere of mutual concern and
cooperation, rooted in traditional discipline. We help build independent, focused, and confident
individuals and families with healthy bodies, spirits, and minds.

Name: ____________________________________________________________________________________
As one means to fulfill our mission, Colorado Blue Wave Martial Arts (COBWAMA) offers scholarships to families with
financial need. This scholarship is in memory of 3rd Degree Black Belt and one of COBWAMA’s founding members
David Curtis. Our rates are already designed to be very affordable for individuals and families, and we have discounts for
families with several members in classes. However, we do realize that sometimes people and families need even more
help than this, hence the scholarship program.

To participate in the program we require that students have one or more of the following characteristics:
      Financial need.                            (Fill this form out)
      In alcohol/drug abuse rehabilitation       (Stop -- fill the 12-step form out)
      Be a criminal assault victim.              (Stop -- fill the assault form out)
      Disclose any relationship to COBWAMA directors, employees, or scholarship selection committee. (Preference
         given to those unrelated, and COBWAMA conflict of interest procedures MUST be followed).
To continue to qualify for the program we ask four things of candidates:
     1. Provide six hours of service to COBWAMA or some other group or individuals
     2. Do a good job of respecting and honoring parents (if 17 or younger)         (as determined by parents)
     3. Do a good job of following do-jang rules and regulations                    (as determined by instructor)
     4. Maintain good standing with the academic school involved in (if 17 or younger and do NOT have a high school
         diploma or equivalent).
Students who do a poor job of following these requests may be dropped from the scholarship program or put on probation
at the next term at the discretion of the COBWAMA board. Because, of fixed costs, and limited funds, we cannot
guarantee scholarship funds will be available. But, we will consider all requests.

Incomplete information may delay processing; incorrect information may result in loss of benefits and/or legal action.
                                 Mail completed application to:
                  COBWAMA c/o Master Erik Kluzek, PO Box 2507, Longmont CO 80502

Application Processing: (for COBWAMA office use only)
Six hours of service provided?            Yes           No                      
Standing with parents (if 17 or younger)? Good          Needs-improvement               Not-satisfactory 
Standing with instructor?                 Good          Needs-improvement               Not-satisfactory 
Standing with academic school?            Good          Needs-improvement               Not-satisfactory 
Application standing?              Approved             Not approved                    Date: ____________
Amount of scholarship: _________________________________
               Colorado Blue Wave Martial Arts is a Colorado non-profit Corporation
    We do not discriminate students on the basis of race, gender, religion, or political affiliation
Personal Information:
Last name: __________________________ First _______________________ MI _____ Date: _______________________________
Male  Female  Parent/Guardian name(s) (if under 18): ____________________________________________________________
Current address: ______________________________________________________________________________________________
Telephone: _______________________                                      Email: _____________________________________
Date of birth: ______________________                                   Age: ________

Optional information:
Black                    Hispanic                  Asian                     Native-American                     White 

Application supporting information:
This is my first application:  (fill out entire form)        Reapplication:  (fill out personal info. and application certification)
Applying for:      Fall scholarship  Fall and Winter Terms                    Spring scholarship  Spring and Summer Terms

Are you related by blood, marriage or any other family relationship to any director of COBWAMA or to any member of the
Scholarship selection Committee? Yes  No 

COBWAMA class attending (or wishing to attend):
     UCAR class in Boulder (Adults)                      tuition normally $60/term
     Tuesday Little Ripples class (6-8 year olds)        tuition normally $30/term
     Tuesday Beginning Breakers class (9 and up)         tuition normally $40/term
     Thursday Tidal Wave class (13 and up or advanced)  tuition normally $60/term
Percentage of COBWAMA tuition you would like to be discounted? 100% (free)        75%                     50% off (half off) 

Will you be able to perform six hours of service (see point 1 on previous page)?           YES              No 
(Service can be time spent helping us with various tasks (sweeping floors, putting things out and away, putting flyers up etc.)
Service can also be provided to other groups (homeless shelter, Habitat for Humanity, church group etc.). Or can be for individuals
you know that need help (rake leaves or shovel snow for elderly neighbors for example).
Will you be able to do a good job of respecting and honoring your parents?        YES             No  I am 18 or older 
Will you be able to do a good job at following COBWAMA rules and regulations?              YES              No 
Are you currently attending school? YES               No  (if of school age, 17 or under, MUST be in school see first page)
School name ____________________________

Income disclosure:
Names of household wage earners:                Number of dependents: _____
Name: ____________________________________________________                          Income level: _________________ /yr
Name: ____________________________________________________                          Income level: _________________ /yr
Extenuating circumstances: Unemployed  Recent divorce (within 3 yrs)  Single Parent  Large medical bills/expenses 
Application certification:
I, __________________________ hereby certify that, under penalty of perjury that the statements and information
provided in this application and any supporting documentation are true. I agree to provide the points outlined on the first
page of this form (service, respect parents, honor do-jang, stay in school) for the term of the awarded scholarship.
Signature: ___________________________________________________            Date: ___________________
Signature of Parent/Guardian (if under 18): _____________________________ Date: _________________
Print Name of parent/Guardian: _________________________________________________

               Colorado Blue Wave Martial Arts is a Colorado non-profit Corporation
    We do not discriminate students on the basis of race, gender, religion, or political affiliation