HEALTH AND WELLNESS FOUNDATION

PERSONAL INFORMATION:

Name:

Home Address:

ACADEMIC INFORMATION:

School:

Current Class Year: ☐ Sophomore ☐ Junior ☐ Senior ☐ Graduate Student

Course of Study or Major:

Expected year of graduation: Cumulative GPA:

Expected enrollment status for next semester: Full-time Part-time hrs.

EXTRA-CURRICULAR ACTIVITIES: Please list activities in which you have participated and any awards or honors received.

YOUR ASPIRATIONS: Please tell us why you have chosen to major in a health-related program. Demonstrate or describe financial need or exceptional circumstances and explain how receiving this scholarship will assist you in achieving your goals.

RELEASE OF INFORMATION: 1 authorize the financial Aid Office to exchange financial, academic and other information deemed necessary in determining my eligibility for this scholarship. I agree to allow the Scholarship Committee to verify any and all information with the appropriate campus offices. I also agree to the release of my information for public relations and/or news releases in conjunction with this scholarship. In signing this application, I certify that the information given is complete and correct.

Date