DISCLOSURE

I hereby certify that my __________________________________attended Conecuh County Training School and is a lifetime member, in good standings of the Conecuh County Training School Alumni Association, Inc. I also certify that the information provided in this application packet is, to the best of my knowledge, true and correct. I have not knowingly withheld any facts that could otherwise jeopardize consideration of my application. In addition, in signing this application I recognize that the material may be used by CCTSAA, Inc. and its chapters for normal business purposes, including publicity and I consent to the use of anything in the application for those purposes. I understand that the awarding of scholarships is based on the availability of funds. I agree to attend the 2009 Alumni Association Banquet, where I will be introduced to the full organization.

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Signature of applicant                                                    Date