MEHA APPLICATION FOR SCHOLARSHIP
(Please print)

NAME____________________________________________________________________

ADDRESS_______________________________________CITY______________________

STATE________________________ZIP__________________ 

PHONE # DAY (__)______________EVENING (__)_________________ 

NAME OF COLLEGE/UNIVERSITY____________________________________________ 

COLLEGE/UNIVERSITY_____________________________________________________

ADDRESS_________________________________________________________________ 

NAME OF ADVISOR_____________________ PHONE # (__)_________ 

DECLARED MAJOR COURSE OF STUDY_________________________

CLASS STATUS (circle one):

          SOPHOMORE     JUNIOR     SENIOR     POST-GRADUATE 

OVERALL GRADE POINT AVERAGE_____________ 

WHAT ARE YOUR CAREER GOALS AND HOW WOULD THIS SCHOLARSHIP AID IN OBTAINING THESE GOALS?  ATTACH ADDITIONAL SHEETS IF NECESSARY.

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PLEASE LIST ACHIEVEMENTS/HONORS/ORGANIZATIONS ETC.

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SIGNATURE_________________________________DATE____________