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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.

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