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SIGNATURE PAGE OF EMPLOYER
Name of Applicant _______________________________________
Country of Applicant _______________________________________
If the applicant is a recipient of a Cyril O. Houle Scholars in Adult and Continuing Education Program award, we agree to administer the award and to provide time to complete the project plan and attend the two required annual retreats.
DEAN OR DIRECTOR |
IMMEDIATE SUPERVISOR |
| Name ____________________________ Title ____________________________ Institution _________________________ Mailing Address ____________________ _________________________________ _________________________________ Phone (______)_____________________ If outside U.S.A., please include country, state, & and city codes Phone Signature _________________________ Date ______________ |
Name ___________________________ Title ___________________________ Institution ________________________ Mailing Address ___________________ _________________________________ _________________________________ Phone (______)_____________________ If outside U.S.A., please include country, state, & and city codes Signature _________________________ Date ______________ |
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