Morris County Hispanic-American Chamber

GALA GOLD SPONSOR

La Abuelita Scholarship Application

Must be present to accept the scholarship award

BUY YOUR TICKETS ONLINE BY DECEMBER 9th 2009

Our 20th Anniversary Celebration

Please fill out this application and submit to our committee. You will be contacted if you are chosen to receive a scholarship.

Join us at this milestone anniversary of our journey and share with other members and supporters of our Chamber

Thursday December 10, 2009, 7:00 p.m. to Midnight
Birchwood Manor, 111 North Road, Whippany, New Jersey
For Information call 973-292-1744

EVENT CHAIR: Esperanza Porras-Field

Name / Nombre

Address / Direccion

DOB /Fecha De Naciemiento

Social Security #

Telephone

Cell

Email / Correo Electronico

Educational Background - Educacion Recibido

In Chronological order list the Institutions, Colleges or Universities attended - En orden cronologico liste liste las instituciones, colegias o universidades atendidas

School Name / Nombre Escuela

State

Dates Attended / Fechas

Diploma / Grado

School Name / Nombre Escuela

State

Dates Attended / Fechas

Diploma / Grado

School Name / Nombre Escuela

State

Dates Attended / Fechas

Diploma / Grado

School Name / Nombre Escuela

State

Dates Attended / Fechas

Diploma / Grado

Have you ever faced any disciplinary actions in your educational career

yes

Enter College Currently Enrolled in along with details of start date degree to be attaned, Part time of full time and WHY you have decided to go back to school

Tell us about yourself and why you feel you deserve this scholarship

Disclaimer

Do you agree that all information provided is truthful to the best of your knowledge?

I agree

I disagree