While full scholarships are not available, we want to do our best to assist you to attend Green Acre Bahá’í School. Please provide the following information, and return your request to us at the address below.

Date of session desired: ________________________________

Name: _________________________________________________ Age: ________________
            ^{(First)                                     (Last)}

Address : ____________________________________________________________________

^{(city)                                         (state)                                             (zip)}

Phone:______________________________________________ Bahá’í ID #: ______________
            ^{(day)                             (home)}

E-mail: ___________________________________________ Fax: ______________________

Ethnic background (optional):__________________

Are you a student?___ yes ___ no Are you a dependent? ___ yes ___ no

Are you employed? ___ yes ___ no

How much of the fee can you pay? $______________

What do I hope to get out of this experience? _______________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Green Acre Bahá’í School, 938 Main Street, Eliot, ME 03903-1800