Scholarship Application
Email Address: *  
Last Name: *  
First Name *  
Middle Initial  
Date of Birth - Year  
Physical Address (no P.O. Boxes) *  
City *  
State *  
5-digit Zip Code *  
Phone Number *  
Alternate Phone Number *  
Occupation  
If currently a student, name of school:  
City, State, and expected graduation  
Do you own a car? *  
Do you own a motorcycle? *  
If you own a motorcycle, please list year, make and model:  
Do you own any/all of the following motorcycle safety equipment? Check all that apply.  
Do you already have a valid license to operate a motorcycle? *  
Do you have a valid license to operate a car in the state you live?  
Gross Yearly Income *  
Type of training you are requesting (please select one): *  
How did you hear about Riders University? *  
Please specify Other:  
Your experience riding a motorcycle: *  
Description of formal rider training completed (MSF, Total Control Training, California Superbike School, etc.)  
Rate the following in order of your riding interests. Use each once. Most Interested: *  
Second interest: *  
Third interest: *  
Fourth interest: *  
Fifth interest: *  
Least Interested: *  
Name of nearest race track or training facility, if known.  
City, State of Nearest race track or training facility, if known.  
All awardees are required to participate in a study on motorcycle skills and safety. Are you willing to complete brief (30 minute) surveys twice a year for 2 years? *  
I understand that if awarded the scholarship, I am required to utilize the training within 45 days. Additionally, I certify all information I have provided in this application is true and correct *  
Please verify all required fields (denoted with *) are complete.