John P. Healy Memorial Scholarship Application

PERSONAL INFORMATION

Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email(Required)

ACADEMIC INFORMATION

High School Attended

School Phone

Cumulative Grade Point Average

List your academic honors, awards and membership activities while in high school

List your community service, hobbies, outside interests, and extracurricular activities

UNIVERSITY/COLLEGE INFORMATION

University/College Name:

University/College Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Planned Major:(Required)

File Uploads

Upload Official Transcript:(Required)

Max. file size: 256 MB.

Upload Essay(Required)

Max. file size: 256 MB.

Tell us in 500 words or less about an experience you had that inspired you to pursue a future in engineering or environmental studies.

STATEMENT OF ACCURACY(Required)

I hereby affirm that all the above stated information provided by me is true and correct to the best of my knowledge. I also consent that my picture may be taken and used for any purpose deemed necessary to promote the DSWA Scholarship program. I hereby understand that if chosen as a scholarship winner, I must provide evidence of enrollment/registration at the college/university of my choice before scholarship funds can be awarded.

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John P. Healy Memorial Scholarship Application