BDI Junior Golfer Information Form
Please complete the following information and click the submit button.

You can aslo print the current page and use the following methods to submit your information:
Fax: 602-258-3412      Mail: 1140 E Washington St., 103, Phoenix, AZ 85034
Name:  
Address:      City:     State:     Zip:  
Age:          DOB:          Phone:  
E-Mail:          Male:          Female:  
Ethnicity     School    and    Golf Information
African
American:  		 Hispanic/
Chicano:  		 Asian/
Pacific Islander:  		 Ameican
Indian:  		 Other (Please Specify):
Age Started Playing Golf:   Handicap:   Avg Score:  
School you are currently attending:  
Do you play on your High School Golf Team? Yes:     No:   Current Grade:   GPA:  
High School Graduation Year:   Interested in a Golf Scholarship?   Yes      No  
Are you a member of The First Tee?   Yes     No   If Yes, what chapter:  
Father's Name:        Mother's Name:  

List Structured Golf Programs in which you have been active:

List Golfing Accomplishments:

Comments:
Please Print this Page for your records:
Click submit to send your information to the
Bill Dickey Scholarship Association
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