Name ____________________________  Home Phone _________ E-Mail _____________

Address __________________________________________________________________
                                                                                           City                   State                 Zip
Are you under the age of 18?  ___ Yes ___ No
If you are over 18, you need to go to the www.usga.org to the amateur status area and download the Application for reimbursement of Tournament expenses.  This needs to be sent to our Foundation with this form.  We will then send the check for you to the HSGA and they will send the travel reimbursement check to you directly. 
If you are under the age of 18 don't worry about the USGA form and we will send the travel expense check directly to you.

   1. Which tournament will you be participating in?
         ___ USGA Jr. Girls Championship    ____ USGA Women's Amateur Public Links 
         ___ USGA Women's Amateur Championship   ___ USGA Women's State Team
        ___  USGA Women's Senior      ____  USGA Women's Mid-Amateur

    2.  Tournament Date(s):____________________________________________________

    3.  Tournament Location: ___________________________________________________
                                                    Course                                               City                                       State

    4.  Estimated Expenses:                                         5.  What percent of the total expense can
         Plane Fare                           ________                    can you or your family provide?
         Ground Transportation         ________                                       ______%
         Hotel                                   ________
         Meals                                  ________
         Other                                   ________    Explain:______________________________
         Total                                 $ ________                 _____________________________

    6.  Will you be able to go to the tournament without stipend assistance? (Please explain)
          __________________________________________________________________

    7.  Will you be receiving assistance from other sources?   Please identify source(s) and amount(s)
         ___________________________________  $ ____________________
         ___________________________________  $ ____________________
         ___________________________________  $ ____________________

   8.  Are you a first time applicant for an HSWGF grant?  ___ Yes  ___No
                                                                                                                                                       
        A.  Tournament ___________________  Date _______________  Location __________
              Amount of Stipend $  ________________  Your results _______________________
        B.  Tournament ___________________  Date _______________  Location __________
              Amount of Stipend $  ________________  Your results _______________________

Grantees are expected to file a written report of tournament experience including a summary of expenses. 
Reports not filed precludes consideration for future grants.  Reports are due within thirty days of tournament completion.

Signature of applicant  ______________________________________  Date:  ____________

Signature of Parent/Guardian (if under 18) ________________________  Date:  __________

Mail to:
Kathy Ordway (HSWGF Treasurer)
350-D Kaelepulu Dr.
Kailua, HI  96734
ordwayk001@hawaii.rr.com