KarMel Scholarship Application 2009

PERSONAL INFORMATION

First Name:

Last Name:

Home Address:

City:

State:

Zip:

Phone:

( )

Email:

Gender:

Birth Date:

EDUCATIONAL INFORMATION

Current Status:

High School Student

College Student

Planning to Go Back to School

School Currently Attending (if applicable):

SCHOLARSHIP DETAILS

· You can submit 1, 2 or 3 submissions in the “Written” category.

· You can submit 1, 2 or 3 submissions in the “Artistic” category.

· You can submit a maximum of 6 submissions.

· You can submit to either or both categories.

· Do not put your written submission into the application. Attach it as a separate file or document.

WRITTEN CATEGORY

Title of Submission Description of Submission (be as detailed as possible)

1)

2)

3)

ARTISTIC CATEGORY

Title of Submission Description of Submission (be as detailed as possible)

1)

2)

3)

MISC INFORMATION

Check the box, if you DO NOT want your name posted next to your submission on the website.

How did you hear about the scholarship? (Check all that apply.)

Scholarship Search Website

GSA/PFLAG

Career Center

Other _____________

CERTIFICATION

My signature below attests:

1. To the accuracy of the information supplied above.
2. That the material submitted is my sole and original work.

3. That the Karmel Scholarship may retain and publish my submission for the KarMel Scholarship website only.

4. All candidates agree to indemnify KarMel Scholarship entirely of any Copyright, Trademark, or other infringement if the situation arises.

5. To my understanding of the purposes, rules, guidelines and conditions of the KarMel Scholarship and to my acceptance of them.

Signature of Applicant *

Date *