*Name as it appears on License:
First:    Middle:   Last:
I am a  
Georgia License Number:  

Home Address
City:  State:  Zip: 

Office Address
Office Name:
City:  State:    Zip: 
Cell Phone:
Office Phone:
*Email Address:

County where company is located:
*Name of Board:
GAR Region Number (if known) where Company is located:

At the time of this application, do you reside in a county designated as a disaster area by appropriate state or federal authorities?
Date disaster occurred (must be within one year of application):  
Have you suffered a financial loss as a result of this disaster?
If yes, please explain:

Have you ever been the recipient of a GAR scholarship?
If yes, in what year did you take the course for which the scholarship was received?  

*Completed Program/Course for which Scholarship will be used:  
If "Other", please explain:
*Course End Date (mm/dd/yyyy):  

*Amount of tuition paid: $ (must have paid for the course in full to be eligible for a scholarship)

*Make check payable to:   

By clicking the "Submit Application" button, I do hereby affirm that the information contained in this application is truthful, accurate and complete.  I further state that I am not GAR staff, or an immediate family member of same.  In the event that it is determined that any information in this application is false, inaccurate or incomplete, the Georgia Association of REALTORS® Scholarship Foundation, Inc. reserves the right to terminate consideration of my application for a scholarship or to revoke any scholarship that may have been awarded to me.  I have read and understand the General Information.

Note: Once you click the "Submit Application" button below, you will be redirected to a page to upload your proof of payment and proof of completion documentation.