Amelia Earhart Memorial Scholarship Application

1 8/1/2017 Page 1 of 1 Amelia Earhart Memorial Scholarship Application Flight Training Instructions The AEMSF General Requirements and Instructions document contains information necessary for Applicants, Chapter AE Chairman and Section AE Chairmen. Download the document at Please read the FULL Requirements and Instructions in the separate document before proceeding. Once completed, submit to your Chapter AE Scholarship Chair. Do NOT submit to the Ninety-Nines Headquarters or to the AEMSF Scholarship Trustees. Application Package Part I: Personal Information Part II: Pilot Experience Part III: Flight Training Course & Funding Requested Part IV: Applicant Essay Part V: Letter of Personal Recommendation Part VI: Documentation Part VII: Applicant Certification Part VIII: 99s Certification Part IX: 99s Recommendation Suggestions for strengthening your AE Flight Training Scholarship Application Establish financial need.

2 Be an active, participating Ninety-Nines member. Strive to find low-cost flight training options. Begin flight training and complete written tests for certificate/rating sought. If short on flight time, have a plan to build time by the end of the Scholarship period, or apply for the certificate/rating for which currently eligible. Do not add supplemental time-building flight hours to Application . Updated 7/31/2017 Flight Training, Academic, Technical TrainingAmelia Earhart Memorial Scholarship ApplicationPart I: Personal InformationName: _____ Previous surname: _____Mailing Address: _____Email address:_____Phones: Home_____Work_____Cell_____(Please indicate which number is preferred with a *)Highest academic level/degree and where obtained: _____Current academic student?

3 (Y/N) _____ Where: _____99sContinuous Membership Date: _____Chapter: _____ Section: _____ScholarshipSpecific Certificate, Rating, or Course Requested:_____Amount Requested in Local Currency: _____ In US Dollars: _____NOTE: AEMSF will use current exchange rate in effect at time of judging to determine final USD AE Scholarships-Year(s) Applied for: _____ Year(s) Awarded: _____Progress made since last AE Scholarship Application or award: _____List all other scholarships received or pending this year:Attach additional page if : Send updates on pendingscholarships to designated AE Trustee immediately upon learning results through February NameAmountPurposeIf Pending, ExpectedNotification DateAviationTotal flight hours: _____Hours flown last 12 months: _____Date and type of flight review, competency or proficiency check, or equivalent: _____Current Medical Certificate/Class: _____ Date of Issue: _____Age: _____Aircraft owned, and percentage of ownership:_____If you own an aircraft, will you use it for this training?

4 If not, why not? : _____2: _____Financial & EmploymentPresent position, employer, and date employed: _____Summary of employment in last five years: _____2: _____Your Annual Gross Income: _____Total Household Annual Gross Income: _____How many people does the total household income support? _____IF YOU ARE CLAIMED AS A DEPENDENT, YOU MUST PROVIDE PARENTAL HOUSEHOLD INCOME IN ADDITION TOPERSONAL INCOME. If you wish to explain the household income above in further detail you may do so in your Essay. You mayalso submit a copy of your prior year s annual tax return directly to the receiving AE Trustee. Black out Social Security Numbers. Updated 7/31/17 Flight Training Amelia Earhart Memorial Scholarship Application Part II: Pilot Experience Applicant Name.

5 _____ Pilot Certificates & Ratings Held Date Obtained mm/dd/yy Pilot Certificates & Ratings Held Date Obtained mm/dd/yy Student Pilot (first solo) ATP Recreational Pilot Other Sport Pilot Other Private Pilot Flight Instructor SE Instrument Multi-Engine Other Instrument Commercial Pilot Other Multi-Engine Other Other Other Knowledge Test Completion Date _____ and Score _____ of Knowledge test for certificate/rating sought (optional but recommended) Note: If completed after Application is submitted, provide update to designated AEMSF Trustee before February 20.

6 Time Building Do not include any time building in the Scholarship amount requested. If you are missing any hours required by regulation to complete your requested certificate or rating, such as PIC cross-country hours for an instrument rating, or total hours for a commercial certificate, please give a detailed explanation here of how you plan to get those hours by the time you complete your training and how you will finance this effort. Record Of Pilot Time (Do Not Write In Shaded Areas) TOTAL HOURS TOTAL HOURS IN PAST 12 MONTHS SOLO HOURS PILOT IN COMMAND (PIC) CROSS COUNTRY INSTRUMENT NIGHT NUMBER OF FLIGHTS NUMBER OF AERO-TOWS NUMBER OF GROUND LAUNCHES NUMBER OF POWERED LAUNCHES AIRPLANES PIC PIC PIC SIC SIC SIC ROTOR- CRAFT PIC PIC PIC SIC SIC SIC POWERED LIFT PIC PIC PIC SIC SIC SIC LIGHTER THAN AIR GLIDERS Updated 7/31/2017 - Flight Training, Vicki Cruse Memorial Emergency Maneuver TrainingAmelia Earhart MemorialScholarship ApplicationPart III: Flight Training Course & Funding RequestedApplicant Name.

7 _____Specific Certificate, Rating, or Course Requested: _____INSTRUCTOR or FLIGHT SCHOOL REPRESENTATIVE: Read carefully, complete, and sign. You are certifyingthat this student can complete this course of training in the training time listed is for entirecost of flight training to complete one pilot certificate or aircraft rating or flight training course. If Applicant is the owneror part owner of the aircraft being used, enter hourly fuel costs under Aircraft Rental below. Do not addsupplemental time-building flight hours and do not include any indirect costs, such as books, travel, food, lodging,aircraft maintenance, insurance, : For training which does not fit into the cost grid below, such asglider or balloon ratings, please attach a separate breakdown with applicable training costs.

8 No reimbursement will be made for training taken before winner has received written notification of herScholarship and the appropriate Trustee has received the winner s signed Official Acceptance Form. If awarded an AE Scholarship , upon proper submission of AEMSF forms and receipts, reimbursement check(s) willbe made jointly to applicant and the school or instructor named below unless applicant provides proof of & Model ofAircraft, Sim, or FTDD escriptionCost PerHourHoursTotal Cost(Local Currency)Aircraft/Sim rental for dual instructionX=Instructor time if not included aboveX=Aircraft/Sim rental for soloX=Aircraft/Sim rental for dual instructionX=Instructor time if not included aboveX=Aircraft/Sim rental for soloX=ENTER TOTAL FLIGHT TRAINING HOURS ---------- All-inclusivecourse Flat Fee(instead of hourly training estimates)=Ground Instruction or SchoolFlat Cost.

9 -OR-X=Flight Check / Practical TestExaminer Fee Flat Fee=Aircraft/Sim rental for flight checkX=SUBTOTALLess employee or other discount-If outside , indicate localcurrency type:TOTAL AMOUNT REQUESTEDin LOCAL CURRENCYC onvert Total Amount Requested to US DollarsTOTAL AMOUNT REQUESTEDin US DOLLARS (Required)By my signature below, I certify that I have completed the above funding request, after evaluating THIS student. The training course and/or aircraft rental and instructor rates are accurate, andINCLUDE PLANNED PRICEINCREASES. I certify that the rates listed above will be honored for the duration of this training course. I have examined the credentials of this applicant, including logbook and other training records, and havedetermined that she is qualified to complete the training course or certificate or rating in the time Name & Title: _____School Name (if any): _____Complete Address: _____Phone: _____Email: _____Sign here:_____Authorized Instructor or Flight School RepresentativeDateOptional E-signatureUpdated 8/10/15 Flight Training,Academic, Technical TrainingAmelia Earhart Memorial Scholarship ApplicationPart IV: APPLICANT ESSAYA pplicant Name: _____Write your essay on this page OR ATTACH ONE SHEET ONLY IN ITS PLACE.

10 Essay may notexceed one page (one side only) and must include at least the following elements: Tell us about yourself, your activities in aviation, and your participation in The Ninety-Nines. Be specific. Describe your goals in aviation or aerospace, and opportunities ahead. Tell us what you have alreadyaccomplished in pursuit of these goals, and towards the specific course or certificate/rating sought. Why are youseeking this specific training? How will it help you to qualify for or to advance in an aviation-related profession orcharitable cause? Tell us how you have financed your training and education so far. Make a statement of financial need for completion of this training. How will awarding you this Scholarship benefit The Ninety-Nines and the aviation community?