Alaska Water Well Association | Scholarship Application

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Biographical Information

Name:

Social Security Number:

E-mail:

High School Graduation or Equivalent: yes no

Address:

City:

State: Zip Code:

Campus Address:

City:

State: Zip Code:

Home Phone:

Work: Campus:

Date of Birth:

Place of Birth:

U.S. Citizen:

yes no

Alaskan Resident: yes no

Current Education

Current School:

Address:

City:

State: Zip Code:

Dept Head / Advisor Name:

GPA: Current Class Standing: Dates Attended:

Academic honors and/or offices held:

Extra-curricular activities:

Education Goals

School you are planning to attend:

Location (city/state):

Degree Goal:

Expected Degree Completion Date:

Plans for Post-Graduate Education:

Other Circumstances / Special Considerations

Do you plan to work while attending school? yes no

Do you plan to pursue a career in the State of Alaska? yes no

Additional Activities and Work Experience

List activities in which you have participated in your school (publications, athletics, music, art, student government, and clubs).

College Activities

Include dates participated, offices held and any special awards and/or honors.

High School Activities

Include dates participated, offices held and any special awards and/or honors.

Volunteer Work

List community activities in which you have volunteered (e.g. church, crisis hot lines, peer groups, hobbies, athletics and
chorus participation).

Include Agency / Organization name, type of work, dates participated and number of weeks.

Employment Experience

List jobs (including summer employment) you have held in the past two or three years.

Include job and type of work, employer, approximate dates of employment, approximate hours per week.

Oath

Please read carefully and click submit.

To the best of my knowledge, I have provided complete information. I am an Alaskan resident and intend to remain so.
I agree to report any factors which could affect consideration of my application. I understand that failure to provide
accurate and complete information may void my application.

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Alaska Water Well Association P.O Box 113156 Anchorage, Alaska 99511 907-522-8324 Karen Henderson, Executive Secretary [email protected] Questions, Comments Concerns with this site email. copyright©2000 Alaska Water Well Association. All rights reserved This site designed by Alaskan Touch

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