Institute for a Democratic Future
Application Form
Class of 2007


Name: ______________________________________________________


Address: ___________________________________________________


City: ____________________________ Zip Code: _______________


Birthdate: ___________	Racial/Ethnic Group: _______________


Phone Number: ______________________________________________


E-mail Address: ____________________________________________


Legislative District: ______ Congressional District: _________


___ I am interested in a need-based scholarship for $____.
* Please include a letter explaining your situation.


___ I am interested in a deferred payment plan.