Scholarship Application

Please read through the “Frequently Asked Questions" page BEFORE filling out and submitting this form.  [See also: Scholarships: Printing and Mailing]


First name : *
Last name : *
Address : *
City : *
State or Province : *
Zip or Postal Code *
Country : *
Primary phone : *
Other phone :
Email address for correspondence with Cymdeithas Madog : *
Age as of July 25, 2010 (applicants for the Mergenthal scholarship only) :
Are you currently a student? *
If you are a student, give the name and address of the school you attend, and indicate whether you are full-time or part-time :
Field of study :
Are you currently employed? *
If you are employed, are you employed part time or full time?
What is your current job title?
Please indicate some of your interests, hobbies, or leisure time activities : *
Please indicate your reason(s) for requesting a scholarship : *
Why are you interested in studying Welsh? *
Have you ever received a scholarship from Cymdeithas Madog? *
If "yes", when did you receive the last one, and what kind was it?
Please check the scholarship(s) for which you are applying : *
 The Naomi Mergenthal Memorial Scholarship: Applicants must be aged 22 or younger, and have not won this award previously.
 Cymdeithas Madog Partial Scholarship: Anyone wanting financial assistance may apply, including those who may have received a scholarship from Cymdeithas Madog previously.
 Matching Scholarship
If you are applying for a matching scholarship, please indicate the name and address of the organization and of the contact person who will be writing the letter pledging funds on your behalf :
I have read the Frequently Asked Questions page (or the Scholarship Information Brochure) and the instructions above and will comply with the procedures explained therein. *
 yes
 no
I understand that a letter of recommendation must be sent to the Scholarship Coordinator by April 10, 2010, in order for my application for scholarship to be considered. *
 yes
 no
If I am applying for a matching scholarship, my sponsoring organization will send the letter of recommendation confirming the amount of money pledged on my behalf. *
 yes
 no
 not applicable
I understand that I must register for Cwrs Cymraeg and send a deposit of £100 (Great Britain Pounds) to the Cwrs Registrar by April 10, 2010 in order for my application for scholarship to be considered. *
 yes
 no
I would prefer to be contacted by (email or regular mail) : *
 email
 regular mail