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Suzuki - Good Scholar Form (Page 2)

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Suzuki - Good Scholar Form
GOOD SCHOLAR AWARD ENROLLMENT/CLAIM FORM
(PAGE TWO)
During the school year for which I am seeking an award, I attended the following elementary school, junior high, high school, or accredited junior college or college:
School Name_____________________________ Address________________________________________________________
PLEASE LIST THE LAST 9 DIGITS OF THE VIN# FOR THE SUZUKI MOTORCYCLE THAT YOU RACE (i.e., 142100007):
Model/Engine Size_______________________________________________ Frame VIN#
uuuuuuuuu
Dealer Purchased From___________________________________________________________________________________
RACE HISTORY
Date
Track
City/State
Class
1. ________ __________________________ ___________________________________________ ____________
2. ________ __________________________ ___________________________________________ ____________
3. ________ __________________________ ___________________________________________ ____________
4. ________ __________________________ ___________________________________________ ____________
5. ________ __________________________ ___________________________________________ ____________
Race Club/Organization(s)_______________________________________________ Phone #_____________________________
Street Address________________________________ City/State__________________________________ Zip______________
Race Club/Organization(s)_______________________________________________ Phone #_____________________________
Street Address________________________________ City/State__________________________________ Zip______________
CHECKLIST
____ 1. I have enclosed a copy of my transcript/report card for the school year for which I am seeking an award.
____ 2. I have maintained a "B", 3.0, or 80% Grade Point Average (GPA), as verified by my official school transcript.
____ 3. I have enclosed proof of ownership of a Suzuki RM65, RM85, RM85L, RM125, RM-Z250 or RM250 motorcycle with a model year corresponding to the
school year for which I am seeking an award.
____ 4. I have listed five organized motocross races prior to July 31 of the school year for which I am seeking an award, and included proof of participation; I
do not need to win, place or show.
____ 5. The Good Scholar Award Enrollment/Claim Form MUST be postmarked to American Suzuki, P.O. Box 1100, Brea, CA 92822 no later than July 31 of the
year for which I am seeking an award
.
I certify that my name, social security number and address as entered are correct for Internal Revenue Service purposes. I understand that the award for the
Program is a $500 U.S. Savings Bond. I understand that ASMC will make no more than one award to me under the terms of the Program.
Signature of Applicant_______________________________________________________________________ Date__________
Signature of Parent or Guardian (if applicant is under 18 years of age)_________________________________________ Date__________

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