Return postmarked application no later than April 1st to:
Branch Name: WEST CENTRAL ILLINOIS QDMA
Contact Name: Jackie Burns
Mailing Address: 576 300TH St.
City: North Henderson State: ILLINOIS Zip: 61466
Contact Number: (309) 368-6028
1. Read the applicant information sheet carefully to
determine eligibility before completing application.
2. Include your full name on the upper left corner of all pages,
3. Make sure all portions of the application are complete and
include all requested enclosures. Incomplete applications
will not be considered.
4. Applicant and school guidance counselor/principal must
sign application.5. Return this application to West Central Illinois QDMA no
later than April 1st. Applications sent directly to QDMA
National headquarters will not be considered