APPLICANT'S NAME____________________________                PAGE 3 of 5

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INSTITUTION FOR WHICH SCHOLARSHIP IS SOUGHT. (MUST BE AN ACCREDITED INSTITUTION OF HIGHER EDUCATIONAL, BUSINESS, SECRETARIAL, OR VOCATIONAL TRAINING SCHOOL)

NAME AND ADDRESS OF INSTITUTION: _______________________________________________________________                                    

ARE YOU PRESENTLY ATTENDING? _____________________________________

IF NOT WHEN WERE YOU ACCEPTED FOR ADMISSION? ___________________

WHAT PROGRAM ARE YOU IN, UNDERGRADUATE OR GRADUATE, FIELD OF
STUDY? _______________________________________________________________

WILL YOU BE A FULL-TIME STUDENT? _______________

WHEN WILL YOU GRADUATE? _______________________

COST PAYABLE DIRECTLY TO INSTITUTION:

ITEMIZE THE ESTIMATED COSTS, PAYABLE TUITION, BOOKS, AND OTHER ACADEMIC FEES FOR THE COMING YEAR.

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EMPLOYMENT EXPERIENCE:    (GIVE EMPLOYER, DATES OF EMPLOYMENT, AND TYPE OF WORK.)

1. ______________________________________________________________

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