2021 Scholarship Application

Name *

First Name

Last Name

Phone *

(###)

###

####

Current Academic Status *

College Student

Santa Barbara Polo Club Waiver *

Do you have a current waiver on file with SBPRC?

Yes

No

USPA Member Status *

Are you a current USPA member?

Yes

No

Are you currently a member of an I/I team? *

Yes

No

Parent Name

First Name

Last Name