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Applicant's Name________________________________________________________________


Home Phone:(____)_________________DOB:_____________Age:____USTA#:____________

Parent or guardian's name:______________________________Work #:(____)_______________

Program applicant has or is presently participating in:___________________________________

E-mail:__________________________________ Fax:__________________________________

Recommender's name:________________________Phone #:(____)_________________________

****  Please complete all of the following before submitting the application.  ****


Have one letter of recommendation written by an individual who is familiar with the child's character and tennis interest.  Have the child write a letter of interest, including their tennis goals for the summer.

Is the child currently a member of the USTA?                                                       Yes (  )   No  (   )

                 ** If not, please enroll by phone or the web!

                 Call 1-800-990-8782 or go to www.usta.com

Does the child currently hold a USTA/MS District ranking?                                 Yes (  )   No  (   )


Has the child ever received a USTA/MS Camp Scholarship?                                Yes (  )   No  (   )


Without financial assistance, would the child be able to attend a tennis camp?     Yes  (  )  No  (  )


Would the child be able to stay overnight at a camp where housing is available?  Yes  (  )  No  (  )


Would the child have transportation and be able to commute daily to a camp

  located within a 45-minute drive of the child's home?                                               Yes  (  )  No (  )




Please indicate area/location/district where child would be interested in receiving the scholarship.




Please return to:  USTA/MS Camp Scholarships

                            1288 Valley Forge Road, Suite 74, P.O. Box 987, Valley Forge, PA 19482

                            610-935-5000 x 239 fax 610-935-5484


Deadline:   April 29, 2005