2024 Norwegian Heritage Class Reimbursement
Application
Submission Deadline: August 31, 2024
for classes attended between September 1, 2023 through August 31, 2024
Applicant Name: ____________________________________
Age ____
(age 23 or younger)
Address: _________________________________________________
City: __________________
State/Province: ____
Zip/PC ________
Email:
________________________________
Phone: ____________
Name of Sponsoring Hadeland
Lag Member ____________________________
Relationship: Self
__ Parent
__
Grandparent __
Great-grandparent __
Hadeland Immigrant Ancestor _____________________________
KHA Skjema/Form # ___ (if
known)
Signature of sponsoring Lag
Member ________________________________________
Class Name _______________________________________________
Grade Level _________________
Class Provider __________________________________________
City ________________
State/Province _______
Class Description
____________________________________________________________________________________
__________________________________________________________________________________________________
Dates Attended _________________________ (September 2022 -
August 2023)
Cost of
this class: _____________
Reimbursement
limited to $250/class
Please
attach
1)
Proof of completion (A written statement by
class instructor indicating successful completion is acceptable. If class is for
college credit, final grade must be “C” or higher)
2)
Proof of payment (receipt or
cancelled check)
All applications for
approved classes by eligible students will be paid until the yearly
reimbursement fund ($500) is exhausted. If you are applying for a class that has
not yet been completed, reimbursement funds will be reserved and payment will be
made when the above proofs and the student’s statement have been received.
Student Statement: Upon class
completion, please tell us in 75-100 words what you learned from this class and
how it affected your understanding of your Norwegian heritage
(use another sheet if necessary)
Signature of Student
______________________________________________________________
Date _____________