EMERGENCY GRANT SCHOLARSHIP
Application Request Form for N.Y. State Applicants Only
Applicants residing in other states - please contact your local lodge 
or the ENF Scholarship Department for applications. 
You cannot be processed through New York State
State Chairman Carl W. Risch, PDDGER

REQUESTOR  MUST COMPLETE ALL FIELDS.
All Elks please give your lodge name and number in comments.
Select One:
MAIL APPLICATIONS TO:
Requestor's Name:
Street:
City:
State & Zip code:
 .....
Area Code and Phone Number:
E-Mail Address:
 Applicant's Name 
 
(If applicant is different from requestor above)
The Parent of Applicant is:
 Disabled...Deceased...N/A
That Parent's Name Is:
That Parent's Lodge is:

(Parent/Stepparent must be a living or deceased member in good standing of a NY State Elks Lodge)
COMMENTS:
 
 
Print & Mail
Completed Requests to:
 
Carl W. Risch, PDDGER
10 Jonathan Drive
Clifton Park, NY  12065
 

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New York State Elks Association

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NOTE: Form must be printed and mailed.  It cannot be sent electronically.