E. ALLEN HENSLEY TEACHER SCHOLARSHIP

2011 APPLICATION

Date:____________________________________________________________________________________

Name:___________________________________________________________________________________

School:__________________________________________________________________________________

Years of Experience in the E-VSC______________

1.  Professional Background:

2. Proposal:  (including anticipated timeline)

3.  Anticipated Professional Benefit

4. Estimated Budget

Applicants Signature:______________________________________________________Date_________________

One additional page of information may be added to the application.  All Applications must be POSTMARKED by

January 16, 20012 and they should be mailed to:

Evansville Retired Teachers Association

c/o Mike Madriaga

200 Brookview Drive

Evansville, Indiana 47711