(to be completed by HEBF Contact ONLY)

The Hilda E. Bretzlaff scholarship applicant, _____________________________, has demonstrated to me a need for financial support in order to attend school.

Please provide an explanation of financial need and a reason why a Tax Return will not be provided to HEBF with the application:

I have the authority to sign because of my position of authority at_____________________, (the school, institution or organization) and understand that if awarded to the above student, this scholarship will be applicable for the 2010/2011 academic year and will be used for tuition and/or books only.

____________________________                                                        _____________________

Signature                                                                                                                            Date

____________________________

Position