Scholarship Application Form

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Scholarship Application
Deadline: March 1, 2013

Date of Application:

* required

Name:

* required

Phone Number:

* required

Full Address:

Univeristy or School Name:

Degree/Major/Minor:

What do you propose to do with the scholarship money?

Describe your professional goals.

Budget: Itemize how you would use the scholarship money. NOTE: Scholarships may not be used for travel or living expenses. It may be used for tuition, professional materials, etc.

Describe yourself, professional and personally, in 250 to 300 words.

Applicant Signature (Sign after Printing):

You can type into the text boxes prior to printing.

All applications must include 2 letters of recommendation: one from your school administrator and the second from either a colleague, a student's parent, or another administrator.

Please print the completed form above and send along with your letters of recommendation by March 1, 2013 to:

Mary Kuperman
652 Rosewood Ct.
Los Altos, CA 94024

Questions: Contact Mary Kuperman