Note: Information must be complete or applications will be disqualified
Sponsoring Board: _____________________________________________________________________
Applicant Name: ______________________________________________________________________
Date applicant was licensed: ____________________________________________________________
Firm: ________________________________________________________________________________
Broker’s Name: _______________________________________________________________________
List all brokerages previously affiliated with and dates of affiliation: ___________________________
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_____________________________________________________________________________________
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Cost of registration and related expenses: _________________________________________________
_____________________________________________________________________________________
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Has applicant received previous Bob Galley Scholarship funds? □ YES □ NO
I understand that The Bob Galley Educational Foundation has offered this scholarship to be used for any
NAR recognized designation. In order to receive scholarship funds, I understand that I must complete and provide evidence of completion of the educational program to the Bob Galley Foundation, 951 Werner
Court, Suite 300, Casper, WY. 82601. Actual receipts must be provided with the certificate of completion in order to receive the scholarship funds.
All applications must be submitted to the WAR office no later than August 1.
Scholarship recipients and the amount of the scholarship will be announced at the WAR Annual Meeting.
Applicant Signature: _________________________________________Date: ___________________
Revised February, 2014