Mike Puhallo Memorial Scholarships
Entry Form
Supported by the BC Cowboy Heritage Society
Name:__________________________________________________________________
Address:___________________________________________
City: _____________________________________
Province/State: _____________ Zip/Postal code:__________
Phone:(____)____________________ Email:___________________________
Will you be attending a post secondary institution in the next 12 months? _____
What are your courses of study going to be? _________________________
What is the name of your present school or college? ________________________
Please list the name or names of a teacher or counsellor as a referral.
_____________________________________________________________________
What was the date of completion of your poem? ______________________
I wish to enter the Mike Puhallo Memorial Scholarship contest. I have read, understand, and accept the
rules and conditions. Signature:___________________________
Print this form, SIGN it, scan it, and email it with your poem as per the rules, to:
cowboys@bcchs.com
Entry deadline December 31st Annually.
Good luck. We look forward to getting your entry.
Supported by the BC Cowboy Heritage Society