Name:
Email:
Whirly-Girl Number:
Whirly-Girls Scholarship Fund, Inc.
International Women Helicopter Pilots
2016 SCHOLARSHIP APPLICATION
This document is the main part of your application. Please include all items below when you email this
document to wgvpsch@whirlygirls.org.
Note: applications missing items from the checklist below are considered to be incomplete and
will be rejected, and your application fee will not be returned.
APPLICATION PACKAGE CHECKLIST
❑
A completed wg-app-2016-part1.doc file. Enter your name, email address, and Whirly-Girl
number at the top of the document. When you enter that information on the first page, verify that it
appears on all pages.
❑
If applying for the Whirly-Girls Helicopter Add-On, the Memorial Flight Training Scholarship,
and/or the Robert and Dayle Walden Memorial Scholarship, be sure to complete the Preliminary
Estimate of Flight Training Costs worksheet. These worksheets require you to estimate the total
cost of flight training in each case.
❑
Complete an essay file for each scholarship for which you are applying. The scholarship files are
as follows:
o
For the Whirly-Girls Helicopter Add-On Flight Training Scholarship:
wg-app-2016-addon.doc
o
For the Agricultural Air Services Flight Training Scholarship:
wg-app-2016-agairservices.doc
o
For the Airbus Flight Training Scholarship:
wg-app-2016-airbus.doc
o
For the Air Evac Lifeteam Bell 206 Transition Flight Training Scholarship:
wg-app-2016-airevac.doc
o
For the Aviation Specialties Unlimited NVG Scholarship:
wg-app-2016-asu.doc
o
For the Advanced Mountain Flight Training Scholarship:
wg-app-2016-mountain.doc
o
For the Antipodean Aviation and Embry-Riddle Wire and Obstacle Environment
Awareness Course Scholarship:
wg-app-2016-antipodean.doc
o
For the Bristow Group Scholarship:
wg-app-2016-bristow.doc
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Name:
Email:
Whirly-Girl Number:
o
For the Embry-Riddle Commercial Helicopter Pilot Ground School Course Scholarship:
wg-app-2016-ercom.doc
o
For the Erickson Vertical Reference/External Load Flight Training Scholarship:
wg-app-2016-erickson.doc
o
For the FlightSafety International Bell 206 Scholarship:
wg-app-2016-flightsafety.doc
o
For the Guidance Aviation Helicopter Instrument Rating Scholarship:
wg-app-2016-guidance.doc
o
For the Whirly-Girls Memorial Flight Training Scholarship:
wg-app-2016-memorial.doc
o
For the Oregon Aero Crew Resource Management Training Scholarship:
wg-app-2016-crm.doc
o
For the Oregon Aero CRM/AMRM Instructor Training Scholarship:
wg-app-2016-crmi.doc
o
For the Robert and Dayle Walden Memorial Scholarship:
wg-app-2016-walden.doc
o
For the Robinson Helicopter R22/R44 Safety Course Scholarship:
wg-app-2016-robinsonsafety.doc
o
For the Robinson Helicopter Maintenance Course Scholarship:
wg-app-2016-robinsonmx.doc
o
For the Survival Systems USA Aircraft Ditching Course Scholarship:
wg-app-2016-survivalsystems.doc
❑
A scanned legible image of your Pilot and/or Instructor Certificate(s).
❑
A scanned legible image of your current Medical Certificate.
❑
Three current letters of recommendation from individuals such as employers, friends, flight
instructors, or Whirly-Girls that can attest to your experience, qualifications, work history, work
ethic, and/or financial need. These documents can be scanned or attached as separate
documents. The letters are a critical part of your scholarship application. Please submit only three
letters and make sure they are legible.
Note: images will be smaller and easier to email if they are scanned in black and white. Be
certain they are legible. Please convert or scan the files to Adobe PDF or JPG files if
possible. Files that we cannot view or convert will have to be resubmitted.
❑
Fee: You may apply for any of the scholarships for which you meet the requirements, with a
single non-refundable application fee of US $45.00.
o
Payment can be made online on our website using Paypal or credit card:
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Name:
Email:
http://www.whirlygirls.org/pay-dues#scholarship
Whirly-Girl Number:
Make sure to enter your Whirly-Girl number so we can attribute the payment to you.
o
Credit card payments can also be made by completing the last page of this document, VISA
or Master Card only. (We cannot accept American Express or Discover Card.)
o
If you prefer to send a check or Money Order (in U.S. currency), you must include a scanned
image of the check with this document and mail it separately. Checks should be made out to
the Whirly-Girls Scholarship Fund. Mail the check separately to Colleen Chen at the address
below:
Colleen Chen
Whirly-Girls Scholarship Fund, Inc.
Post Office Box 437
Franconia, NH 03580
Make sure to specify the payment is for a scholarship application, and enter your
Whirly-Girl number on your check so we can attribute the payment to you.
❑
IF YOU ARE PAYING BY CREDIT CARD, INCLUDE YOUR CREDIT CARD INFORMATION IN
THE APPLICATION by signing and scanning the completed remittance form (the last page of this
file, wg-app-2016-part1.doc). For your security, this page will be deleted from your application
once the payment is processed.
❑
Please note: if you are selected for a scholarship, you will be asked to provide a professional
picture.
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Name:
Email:
Whirly-Girl Number:
Ranking Sheet
Ranking Directions: You may apply for any of the scholarships for which you meet the requirements and
wish to be considered. Please rank your choices in order of your priority from 1 – 19 with the most
preferred being 1 and the least preferred being 19 as appropriate. The Scholarship Independent
Judges will evaluate the applications according to a point system.
Rank 1-19
Scholarship Options
Whirly-Girls Memorial Flight Training Scholarship
Whirly-Girls Helicopter Add-on Flight Training Scholarship
Advanced Mountain Flight Training Scholarship
Agricultural Air Services Flight Training Scholarship
Airbus Flight Training Scholarship
Air Evac Lifeteam Bell 206 Scholarship
Antipodean Aviation and Embry-Riddle Wire and Obstacle Environment Awareness
Course Scholarship
Aviation Specialties Unlimited NVG Scholarship
Bristow Group Scholarship
Embry-Riddle Commercial Helicopter Pilot Ground School Course Scholarship
Erickson Vertical Reference/External Load Flight Training Scholarship
FlightSafety International Bell 206 Scholarship
Guidance Aviation Helicopter Instrument Rating Scholarship
Oregon Aero Crew Resource Management Training Scholarship
Oregon Aero CRM/AMRM Crew Instructor Training Scholarship
Robert and Dayle Walden Memorial Scholarship
Robinson Helicopter R22/R44 Safety Course Scholarship
Robinson Helicopter Maintenance Course Scholarship
Survival Systems USA Aircraft Ditching Course Scholarship
●
Unless otherwise specified in the scholarship’s description, scholarships cover only flight time.
Scholarship winners are responsible for their own transportation to, from, and during training, all
accommodations, ground school costs, materials, books, meals and expenses.
●
Scholarships must be used by 31 December 2016.
●
Winners must sign a Letter of Agreement and abide by scholarship rules, or the scholarship may
be forfeited.
●
In the event that a qualified applicant does not apply for a particular scholarship, the Scholarship
Committee reserves the right to not award that scholarship. Qualified applicants must meet the
minimum requirements for the scholarship for which they are applying.
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Name:
Email:
Whirly-Girl Number:
2016 Whirly-Girls Scholarship Application Questionnaire
PERSONAL INFORMATION
Name (First, Middle, Last)
DOB (Month, Day, Year)
Permanent Mailing Address: Number and street, P.O. Box,
etc.
Citizenship
City, State, Zip Code
Employer
Exact title of position
Home and Cellular phone (including area code)
Office phone (including area code)
Airman Certificates:
List all Airman Certificates that you hold. Include the date obtained, category, class, rating, and any other
important information.
List all Aircraft Make/Model/Series specific qualifications that you have obtained.
Medical:
Class and Date of Medical Certificate
(Attach a scanned copy of your medical certificate):
Date of current exam______
Class__________________
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Name:
Email:
Whirly-Girl Number:
FLIGHT EXPERIENCE
AIRCRAFT CATEGORY:
Make/Model
Turbine Hours
Reciprocating Engine Hrs
Cross Country Hours
Instrument Hours
Helicopter - Total PIC
Airplane – Total PIC
Helicopter Last 6 Months
Airplane Last 6 Months
Helicopter Last 5 Years
Airplane Last 5 Years
TOTAL FLIGHT TIME
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Name:
Email:
Whirly-Girl Number:
EDUCATION AND TRAINING
Education &
Training
Name
City and
State
Date
From/To
Degree or
highest level
attained
Major/Minor
High School
College, trade
school, special
course, or
seminar
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Name:
Email:
Whirly-Girl Number:
EMPLOYMENT RECORD: LIST MOST RECENT EMPLOYER FIRST
COMPANY NAME
ADDRESS: STREET NO. AND NAME, CITY, STATE, ZIP CODE
DATES FROM/TO
YOUR JOB TITLE / YOUR SUPERVISOR’S NAME
REASON FOR LEAVING
DESCRIBE YOUR JOB DUTIES:
COMPANY NAME
ADDRESS: STREET NO. AND NAME, CITY, STATE, ZIP CODE
DATES FROM/TO
YOUR JOB TITLE / YOUR SUPERVISOR’S NAME
REASON FOR LEAVING
DESCRIBE YOUR JOB DUTIES:
COMPANY NAME
ADDRESS: STREET NO. AND NAME, CITY, STATE, ZIP CODE
DATES FROM/TO
YOUR JOB TITLE / YOUR SUPERVISOR’S NAME
REASON FOR LEAVING
DESCRIBE YOUR JOB DUTIES:
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Name:
Email:
Whirly-Girl Number:
USE A SEPARATE SHEET IF NECESSARY
Honors / Awards / Scholarships you have received:
Organizations with which you are affiliated:
Activities or hobbies:
Involvement in aviation-related activities such as ground school, research project for school,
civic presentations, etc.:
What achievements / contributions have you made in aviation?
What originally sparked your interest in the helicopter industry?
How have you helped other women become interested in aviation?
Please tell us briefly about your personal experiences in aviation.
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Name:
Email:
Whirly-Girl Number:
Are you provided discounted or free access to helicopter flight time or instruction? If yes, please
explain.
Why do you need this financial assistance? Please be specific.
Whirly-Girls Only:
What month and year did you become a Whirly-Girl?
Have you received a Whirly-Girl Scholarship in the last four years?
What have you done to support and promote the Whirly-Girls organization? (Volunteered for the
HELI-EXPO or WAI merchandise booth and/or committees, served as a board member,
mentored another Whirly-Girl, hosted a WHOW meeting or hovering, etc.)
Have you attended any Whirly-Girls Annual Meetings, WHOWs, or hoverings in the past 10
years? Please indicate dates and locations.
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Name:
Email:
Whirly-Girl Number:
STATEMENT OF UNDERSTANDING FOR COMPLETION REQUIREMENT:
● Winners must provide the Scholarship Director a plan by no later than 31 July 2016 to
use the scholarship prior to 31 December 2016, sign a contract, and abide by all
scholarship rules. If a plan is not received by 31 July 2016, then the scholarship will be
given to the next qualified applicant. Scholarships must be used by 31 December 2016.
● Winners will write an article for the Collective Pitch in the scholarship year of their
selection and volunteer at least five hours to the organization either through working at
one of the Whirly-Girl booths at an event or some other service approved by the Board.
● By entering my name on this line, I understand that if training is not completed within this
allotted time, the scholarship winner agrees to repay all used funds to the Whirly-Girls
Scholarship Fund.
Name: ___________________________________
Date: _______________
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Name:
Email:
Whirly-Girl Number:
The following financial information will remain completely confidential and will only be
seen by scholarship committee members. Upon completion of the selection process, it
will be destroyed.
Complete this section if applying for the Whirly-Girls Helicopter Add-On
or Memorial Flight Training or the Robert and Dayle Walden Memorial
Scholarships ONLY
The value of the Memorial, Add-On, and Robert and Dayle Walden Memorial scholarships may
provide only a portion of the total cost of flight training. If the scholarship does not provide full
funding for a targeted goal, how do you intend to fund the remaining portion of flight training?
(Also complete page 13 below.)
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Name:
Email:
Whirly-Girl Number:
Complete this section if applying for the Whirly-Girls Helicopter Add-On
or Memorial Flight Training or the Robert and Dayle Walden Memorial
Scholarships ONLY
Preliminary Estimate of Flight Training Costs
Flight Training Provider Name and Address:
Type of rating sought:
Hours:
Minimum Flight Hours
(Helicopter/Type) Estimate
Cost per flight hour:
Subtotal:
Scholarship value (applies only to flight training):
Hours:
Cost per hour:
Subtotal:
List Items:
Total Cost of Listed
Items:
Subtotal:
Ground School
(Not covered by scholarship)
Materials, Books, Meals,
Lodging and Miscellaneous
Expenses (please explain)
(Not covered by scholarship)
Total Cost of Flight Training,
Ground School and
Miscellaneous Expenses:
I understand that the quote is only an estimate of costs and that costs may vary among
training providers. Furthermore, I understand that the value of the scholarship provides only
a portion of the total cost of flight training. Whirly-Girls Add-On/Whirly-Girls Memorial/Robert
and Dayle Walden Memorial Scholarship Applicants: this form must be completed so that
you understand your additional financial obligations in order to complete this scholarship.
By typing my name and the date on the line below, I acknowledge that I understand my
financial obligations for the Whirly Girls Add-On/Whirly-Girls Memorial/Robert and Dayle
Walden Memorial Scholarships:
____________________________________ ______________
Applicant Name
Date
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Name:
Email:
Whirly-Girl Number:
2016 Whirly-Girls Scholarship Application
(If paying by credit card, please fill out the Credit Card section below, print this page,
sign it, and scan it. Include it with the other submitted materials.)
REMITTANCE PAGE
Name:
Address:
Phone:
Email:
CHECK:
If Paying by Check or Money Order (In US Dollars, only):
Check Number:
(no international checks please)
Include a scanned image of check or Money Order. Mail the check as directed in the
“Checklist” at the beginning of this document.
CREDIT CARD:
If paying by credit card, please provide the following information:
Select one:
Master Card
_____ VISA
(We cannot accept American Express or Discover Card.)
Card Number:
Expiration Date:
Signature:
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