North American Racewalking Foundation
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PROTOCOL		 HEPPNER FUND
APPLICATION FORM
 
NORTH AMERICAN RACEWALKING INSTITUTE (NARI)
 
AL HEPPNER MEMORIAL FUND - APPLICATION FORM
 
Please read the Protocol governing the Al Heppner Memorial Fund.  You must be a sophomore, junior or senior to receive this award.  You must also meet the men's qualifying standard of 1:43:00 (IAAF Men's "A" standard of 1:23:00 + 20 minutes), or the women's qualifying time of 1:54:30 (IAAF Women's "A" standard of 1:33:30 plus 21 minutes).  20K times must be made on a certified track or road course with at least three competitors and the appropriate number of certified judges.  10K and 5K times are optional.  Again, please read the full protocol.
 
NAME: 
 BIRTH DATE: 
ADDRESS: 
 SEX:  M    F 
CITY/STATE/ZIP CODE 
E-MAIL ADDRESS: 
 PHONE: 
COLLEGE: 
 LEVEL: 
COACH: 
 PHONE: 
BEST 20K TIME IN 2005: 
 DATE MADE: 
RACE: 
 LOCATION: 
CHIEF JUDGE: 
 RACE DIRECTOR: 
TELEPHONE AND/OR E-MAIL OF RACE DIRECTOR: 
COURSE CERTIFICATION NUMBER: 
RACE PARTICIPATION: 
USATF NATIONAL JUNIOR OLYMPICS: 
 TIME: 
 DATE: 
USATF YOUTH ATHLETICS NATIONALS: 
 TIME: 
 DATE: 
USATF JUNIOR NATIONALS: 
 TIME: 
 DATE: 
USATF SENIOR (OPEN) NATIONALS: 
 TIME: 
 DATE: 
OVERALL STANDING IN THE USATF RACEWALK GRAND PRIX CIRCUIT: 
BEST 10K TIME IN 2005: 
 DATE MADE: 
RACE: 
 LOCATION: 
CHIEF JUDGE: 
 RACE DIRECTOR: 
TELEPHONE AND/OR E-MAIL OF RACE DIRECTOR: 
COURSE CERTIFICATION NUMBER: 
BEST 5K TIME IN 2005: 
 DATE MADE: 
RACE: 
 LOCATION: 
CHIEF JUDGE: 
 RACE DIRECTOR: 
TELEPHONE AND/OR E-MAIL OF RACE DIRECTOR: 
COURSE CERTIFICATION NUMBER: 
Please submit the following with your application:
  1. A typewritten essay on your commitment to race walking, your goals, and how you plan to achieve them.  The essay is not to exceed one typewritten page.
  2. Two letters of recommendation.
  3. A copy of your grade report showing a B (3.0) or better grade point average.
Your application must be post marked no later than October 15 of each year.  No late submissions will be accepted.  No exceptions will be made.
 
Send your application to:
 
          North American Racewalking Institute
          358 West California Blvd., #110
          Pasadena, CA 91105-2926
 
If you have questions, please contact Elaine Ward at:
 
          E-Mail: narwf@sbcglobal.net
          Telephone: 626-795-3243 or 626-799-1206
 
Best wishes to you for a successful competitive season.
 
Elaine Ward
 
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