APPLICATION FOR
MID-ATLANTIC HORTICULTURAL SHORT COURSE SCHOLARSHIP * indicates required fields
Name*:
SSN: (optional)
Email
Address*:
School:
Facility:
Local Address:
Home Address if different:
Home
Phone Business or School Phone*:
Date of Birth:
Sex:
MaleFemale
Are you currently employed?
Yes
ACADEMIC (Email a copy of
latest university / college transcript)
College/University currently attending:
Major:
Advisor:
Advisor Phone:
Attending School:
Part-timeFull-time
Other colleges attended
(fill in the following):
Previous College(s)
Location
Dates Attended
Major
Degrees
GPA
1
2
3
4
EXTRA-CURRICULAR ACTIVITIES Current activities and organization memberships, offices,
and awards:
Employment experience (provide
employer’s name and address and your responsibilities).
FINANCIAL
Make a brief statement of your financial situation describing
how you meet school
expenses (tuition, books, housing, etc.). Include any
financial assistance you receive from
family, your personal contributions.
Have you received, or do you
expect to receive, other loans, awards, or scholarships to
help
you with college expenses? If so, cite amounts and academic
year of receipt.
BACKGROUND STATEMENT
Describe your current studies and career objectives.
REFERENCES
Name
Address
Phone
I,
hereby
acknowledge that all of the information included in this
application is true and complete to the best of my knowledge.
I agree to the release of this information to the scholarship
sponsors.
