Daniels Fund :: Scholarships Contact Us

Please complete the form below to express your interest in becoming a Daniels Scholarship Referral Agency. All respondents must be affiliated with a high school in Colorado, New Mexico, Utah and Wyoming.

Please note: The deadline to register as a Daniels Fund Referral Agency is Monday, December 1, 2009. The form below is for high schools interested in serving as Referral Agencies. Any youth serving agency that is interested is asked to please contact the Daniels Fund at 303-393-7220 or Toll Free 1-877-791-4726 for the appropriate documents.

Yes, we are interested in being a Daniels Scholarship Referral Agency.
No, we're not interested at this time.

High School Name
Mailing Address
City
State	Zip Code
School Website
Principal
	Email
	Phone
	Fax
Primary High School Contact
	Email
	Phone
	Fax
Of your students, how many are in the:
12th grade
11th grade

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