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* 1. Please provide your first and last name.

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* 2. Please provide your date of birth.

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* 3. What is your address?

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* 4. What is your email address?

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* 5. What is your phone number?

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* 6. Marital Status:

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* 7. Number of Dependents - Include age(s):

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* 8. Employment Status:

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* 9. Household Income Level:

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* 10. Overall debt level (not including Home/Mortgage Debt):

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* 11. If you are selected for the scholarship which race are you interested in for the Shamrock Race Weekend?

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* 12. Please briefly describe your running/walking history. What's the furthest you've run? Are you currently active? Have you run or walked a race before? **Please note, preference will not be given based on this question.**

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* 13. Please use the space provided to describe why you should be selected to receive this need-based scholarship for the J&A Racing Team and Race Entry. What do you think you will achieve by training for this race and crossing the finish line on race day? How will it impact your life?

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* 14. How did you hear about the J&A Racing Training Team Scholarship?

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* 15. J&A Racing and the scholarship committee reserve the right to request proof of income and debt if questions arise during the selection process. Applicant must provide proof if requested in order to be awarded the scholarship. Please initial in the box below that you acknowledge this requirement. 

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* 16. Thanks to a generous donor in our local community, J&A Racing and the training team are excited to invest in you, your running goals, and most importantly your person growth. The journey to arriving at the starting line of the race can be more impactful than actually crossing the finish line. In order to make sure you receive the most from this experience, participation in the team launch party, team socials, and team runs is required. If I am awarded this scholarship, I agree to actively participate in the experience - team launch party, team socials, and team runs. Please initial below.

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