2023 Norwegian Heritage Class Reimbursement Application

Submission Deadline: August 31, 2023

for classes attended between September 1, 2022 through August 31, 2023

 

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 ________________________________________

 


Norwegian Class Information

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 _____________