Request for Consideration Javascript is required to submit this form. Applicant Information * All form fields labelled with an asterisk (*) are required. Applicant Full Name First Name* Last Name* Applicant Address Street Address* Address Line 2 Country* Canada USA State / Province / Region* Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming City* Zip / Postal Code* Applicant Contact Information Email* Phone Number* Applicant Employer Information Current Occupation* Previous Occupation(s) Applicant Financial Information Current Salary / Annual Income* Funds Available for Investment* Typical investment ranges from $150,000-$225,000 Co-Applicant's Information Do you have a Co-Applicant, Spouse or Partner to be involved? * Yes No Co-Applicant's Full Name First Name Last Name Co-Applicant's Address Street Address Address Line 2 Country Canada USA State / Province / Region Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming City Zip / Postal Code Co-Applicant's Contact Information Email Phone Number Co-Applicant's Employer Information Current Occupation Previous Occupation(s) Co-Applicant's Financial Information Current Salary / Annual Income Funds Available for Investment Centre Development Information * All form fields labelled with an asterisk (*) are required. Have you ever visited a Scholars Centre? * Yes, I have previously visited a Scholars Centre. No, I have not previously visited a Scholars Centre. If we select each other, my involvement will be: * Full-Time Operator Spouse/Active Partner Absentee Operator (Investment Only) Part-Time Director with Other Business Interests Other If other is selected, please specify your involvement.* Why have you approached Scholars Education Centre? What specifically interests you about the opportunity?* Time Frame for Opening * Within 3 Months 3 - 6 Months 6+ Months Other If other is selected, please specify your involvement.* Desired location/city for centre.* About Me * All form fields labelled with an asterisk (*) are required. Tell us a little more about yourself, your family, your hobbies, and your community.* What community activities are you currently involved with?* What makes you a good match for the Scholars system?*
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