The Anyone Can Fly Foundation, Inc.

Professional Scholars Grant Application Form

Please fill in the fields below and mail your application with accompanying documents
to the Foundation not later than February 28, 2007. See full instructions.

Name in full (Surname in capitals)

Mailing Address

Street

City

State

Postal Code

Country

Home Address if other than above
Note: Home Address must be a Street Address. Do not leave blank.

Street

City

State

Postal Code

Country

Telephone Do not leave blank.

Fax

Cell

Email address

Place of Birth

Date of Birth

Sex

Citizenship

Name, mailing address, and telephone
number of spouse or nearest relative

Name of spouse or nearest relative

Street

City

State

Postal Code

Country

Employer Name and address

Employer Name Do not leave blank.

Street

City

State

Postal Code

Country

Additional Information About the Applicant

Profession

Education

Project Proposal

Present a Project Proposal on William H. Johnson, Edmonia Lewis, Harriet Powers, or Charles White. Enclose a list of images along with documentation that you have identified the rightful copyright owner(s) and a written response on their letterhead affirming that they are indeed the legitimate copyright holder and they are able to grant the Anyone Can Fly Foundation copyright permission for the proposed project.

I, ______________________________________________ (the Author) warrant to the Anyone Can Fly Foundation, Inc. (the Foundation) that I am the sole author of the proposed work. The proposed work will be an original work which has never been published in whole or in part in any form throughout the world. The proposed work will contain no material that is libelous, in violation of any right of privacy or publicity, or harmful so as to subject the Foundation to liability to any third party or otherwise contrary to law.

After completing this form, print it out, sign and date it.
Signature:
Date Mailed:

Click here to return to instructions and mailing address.

© 2002-2007 The Anyone Can Fly Foundation, Inc. This site is hosted by the Center for Arts Management and Technology. All rights reserved. Use of art work without express written consent from the copyright owner is a violation of copyright law. Email enquiries@anyonecanflyfoundation.org for information about how to contact the copyright owners of any of these pictures.