FREEDOM OF CHOICE OHIO—THE OHIO PRO-CHOICE COALITION APPLICATION FOR FOCO SCHOLARSHIP FUNDS FOR BUS COSTS TO MARCH FOR WOMEN’S LIVES ON APRIL 25, 2004 FROM COLUMBUS, OHIO TO WASHINGTON, D.C. NON-STUDENT APPLICANTS Scholarship Information The FOCO Scholarship will provide $40 of the $65 cost of the bus fare. $25 is to be paid by the applicant. Applicant may apply for self and family members, but must pay $25 per family member. Applicant must be a resident of Ohio Application forms must be mailed by March 25 to FOCO, 760 E. Broad St. Columbus, OH 43205, or they may be emailed by March 28 to jaime@naralohio.org. A screening committee will review applications on April 2 and notify applicants by email whether or not they are to receive the scholarship. Applicants who do not have email will be notified by telephone. Please give both email and telephone numbers below. Scholarships will be paid directly to the organization providing bus service from the applicant’s area in the name of the applicant. Applicants must pay their $25 to receive their scholarships. Checks for $25 which identify the scholarship recipients shall be sent to the local organization providing bus service to the applicant’s home area. For more information about bus service from your home area please contact the person listed below for your local planned parenthood, if you are not sure which area you are located in, please e-mail Jaime@naralohio.org or call 614-221-2594. o Planned parenthood Stark County, 330-456-5329 o Planned Parenthood Southeast Ohio, 740-539-3375 o Greater Cleveland March Hotline, 216-334-2212, or marchforchoice@ppgc.org o Planned Parenthood Northwest Ohio, 419-255-1123 o Planned Parenthood Mahoning Valley, 330-788-6506 o Planned Parenthood Cincinnati Region, 513-721-7635 o Planned Parenthood North Central Ohio, 419-525-3080 o Planned Parenthood Central Ohio, 614-224-2235 or columbusmarch4choice@yahoo.com o Planned Parenthood Summit. Portage & Medina Counties, 330-535-2674 o Planned Parenthood Greater Miami Valley, 937-226-0780 FREEDOM OF CHOICE OHIO—THE OHIO PRO-CHOICE COALITION APPLICATION FOR FOCO SCHOLARSHIP FUNDS FOR BUS COSTS TO MARCH FOR WOMEN’S LIVES ON APRIL 25, 2004 FROM COLUMBUS, OHIO TO WASHINGTON, D.C. Applicant Name: ___________________________________________________ Address:___________________________________________________________ City:___________________________________ Zip code________________ Telephone: (Day)__________________________(Evening)__________________ Email:______________________________________________________________ Requests for ___ scholarships for named applicant and these family members: Name:________________________________ Relationship:__________Age:_____ Name:________________________________ Relationship:__________Age:_____ Name:________________________________ Relationship:__________Age:_____ Name:________________________________ Relationship:__________Age:_____Y Character reference: (person who can vouch for your credibility) Name:_______________________________________ Phone no.:_______________ You must answer the questions 1 and 3 in order to be considered for the scholarship. 1. I need to have a scholarship (or scholarships) for the following financial reasons: (Suggestions: information about total income, wages, other sources of income, number of dependents, total expenses, etc.) 2. I need a scholarship (scholarships) for the following non-financial reasons: (Optional: suggestions—temporary emergencies, future contingencies affecting available financial resources.) 3. I want to participate in the March for Women’s Lives on April 25, 2004 because: The information that I have provided in this application is true and accurate, to the best of my knowledge. _______________________________ Applicant’s signature