Name: Street Address: City: State: Zip Code: Day Phone: Email address:
Are you a Bellevue resident? Yes No
I am requesting financial assistance
Why are you seeking admission to this program?
How do you hope to use your expertise for the benefit of the community?
If admitted, I commit to attend a minimum of 80 percent of the scheduled sessions.
I accept (By selecting the "I accept" button, you are signing this application electronically.)
450 110th Ave NE
PO Box 90012
Bellevue, WA 98009
Contact: Julie Ellenhorn