ECLAT Gallop Graduate School Scholarship Application

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Full Name* This field is required.
First Name
Last Name
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Gender* This field is required.
Male
Female
Other
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Birth Date* This field is required.
Date
Year
Month
Day
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Country Code
Area Code
Phone Number
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School Name* This field is required.
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School Major/Degree* This field is required.
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School Year* This field is required.
Freshman
Sophomore
Junior
Senior
Master
PHD
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Parent's Name* This field is required.
First Name
Last Name
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Parent's Phone Number* This field is required.
Country Code
Area Code
Phone Number
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Home Phone Number* This field is required.
Country Code
Area Code
Phone Number
12
Source of Funds Secured* This field is required.
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Scholarship Request* This field is required.
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Photo* This field is required.
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Family MembersPlease list out all of your family members
Name
Relationship
Name
Age
Health Status
School/Employment
Education Level
Monthly Income
Notes
Member 1
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Member 2
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Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Row 1, Column 7
Row 1, Column 8
Member 3
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Row 2, Column 5
Row 2, Column 6
Row 2, Column 7
Row 2, Column 8
Member 4
Row 3, Column 0
Row 3, Column 1
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Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Row 3, Column 7
Row 3, Column 8
Member 5
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Row 4, Column 6
Row 4, Column 7
Row 4, Column 8
Member 6
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Row 5, Column 6
Row 5, Column 7
Row 5, Column 8
Member 1
Member 2
Member 3
Member 4
Member 5
Member 6
Name
Row 0, Column 0
Relationship
Row 0, Column 1
Name
Row 0, Column 2
Age
Row 0, Column 3
Health Status
Row 0, Column 4
School/Employment
Row 0, Column 5
Education Level
Row 0, Column 6
Monthly Income
Row 0, Column 7
Notes
Row 0, Column 8
Name
Row 1, Column 0
Relationship
Row 1, Column 1
Name
Row 1, Column 2
Age
Row 1, Column 3
Health Status
Row 1, Column 4
School/Employment
Row 1, Column 5
Education Level
Row 1, Column 6
Monthly Income
Row 1, Column 7
Notes
Row 1, Column 8
Name
Row 2, Column 0
Relationship
Row 2, Column 1
Name
Row 2, Column 2
Age
Row 2, Column 3
Health Status
Row 2, Column 4
School/Employment
Row 2, Column 5
Education Level
Row 2, Column 6
Monthly Income
Row 2, Column 7
Notes
Row 2, Column 8
Name
Row 3, Column 0
Relationship
Row 3, Column 1
Name
Row 3, Column 2
Age
Row 3, Column 3
Health Status
Row 3, Column 4
School/Employment
Row 3, Column 5
Education Level
Row 3, Column 6
Monthly Income
Row 3, Column 7
Notes
Row 3, Column 8
Name
Row 4, Column 0
Relationship
Row 4, Column 1
Name
Row 4, Column 2
Age
Row 4, Column 3
Health Status
Row 4, Column 4
School/Employment
Row 4, Column 5
Education Level
Row 4, Column 6
Monthly Income
Row 4, Column 7
Notes
Row 4, Column 8
Name
Row 5, Column 0
Relationship
Row 5, Column 1
Name
Row 5, Column 2
Age
Row 5, Column 3
Health Status
Row 5, Column 4
School/Employment
Row 5, Column 5
Education Level
Row 5, Column 6
Monthly Income
Row 5, Column 7
Notes
Row 5, Column 8
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Total Monthly Household Income* This field is required.
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Total Monthly Household Expenditure* This field is required.
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Residence* This field is required.
Renting Home
Own Home
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Low-Income CertificateIf this document does not apply to you, please press next.
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20
Subsistence Allowance DocumentIf this document does not apply to you, please press next.
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Disability CertificateIf this document does not apply to you, please press next.
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FAFSA (USA)If this document does not apply to you, please press next.
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Severe Injury ProofIf this document does not apply to you, please press next.
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24
Other Supporting DocumentsIf this document does not apply to you, please press next.
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25
Have you ever received ECLAT Foundation's student subsidy or attended any ECLAT activities? Explain * This field is required.If you have not, you can just put no
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If someone recommended this to you, please put their name
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[My Family] Ex. Family current situation? Interaction between family members?* This field is required.
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What is your current Major and what is your favorite course? What graduate school and major are you planning on pursuing? and Why?* This field is required.
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What is your career goals? What are your life goals?* This field is required.
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How much funding will be required for your first year of graduate school studies in the US? List your source(s) of funding that you have already secured. How much funding are you applying for from ECLAT? If you receive the Gallop Scholarship from ECLAT, how do you plan to use the fund?* This field is required.
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Please talk about what you know about the ECLAT foundation. Please share your experience participating in any ECLAT Foundation activities or other public service activities?* This field is required.
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