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District 19 2011-2012 Scholarship Application Form

District 19 2011-2012 Scholarship Application Form

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Published by delegatearora
District 19 2011-2012 Scholarship Application
District 19 2011-2012 Scholarship Application

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Categories:Types, Legal forms
Published by: delegatearora on Mar 16, 2011
Copyright:Attribution Non-commercial


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Important! All Applications and required documentation must be submitted as early as possible and postmarked nolater than May 16, 2011.
Please print clearly and complete
pages of this form. It is the responsibility of all applicants to ensurethat their application, essay, and TRANSCRIPTS are received by the Delegates’ Office. This form should be signed and submitted by mailalong with the other documents for consideration.
You MUST be a resident of Maryland Legislative District 19 and have attended a Maryland high school to qualifyfor this House of Delegates Scholarship
Please write the name of the school you will be attending below. If you are attendingan out-of-state school due to a
unique major 
, consult the MHEC website (www.mhec.state.md.us.
) for approval. To verify your legislative district, visithttp://mlis.state.md.us. Select the “Find a legislator” link and complete the lookup form or call 240-777-VOTE.
Name of the school you will attend in the Fall of 2011: Is it out of State: Yes No
Degree you are seeking:
Date You Accepted: (mm/yyyy)Full Time Student or Part Time Student (less than 12 credits)Undergraduate Major:Unique Major? Yes No If yes, please describe below:Comments:Personal Essay: Write and submit an essay on one of the following. Limit is 500 words, double spaced:
1. Profile yourself 10 years from now. Who will you be and what will you be doing? 2. What going to college means to me and why 
List any Academic honors and other Awards:List recent Work Experiences:List any additional school, extracurricular, home, work, or community activities below or on a separate page:
__________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 
Please complete BOTH pages of this application and mail as soon as possibleFinal Deadline: May 16, 2011StudentName:
First Middle Last
Street/ Apt. No.City State Zip
Current Address (if not same as Home)
Street/ Apt. No.City State Zip
number:(circle preferred)
Daytime: Cell: Evening:
Social Security or ITIN No.
SS # or ITIN #
Date/Place of Birth:
Date: Place of Birth:
Email Address:
Marital Status Single Married
Do you live withyour parents?
Yes NoIf yes, how many children are dependent on your parents?_________________ 
2011-2012 Maryland House of Delegates Scholarship Application
Delegates Arora, Cullison and Kramer:
District 19 Montgomery County

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