NJEHA Conference Gary S. Strauss Scholarship Fund

Complete the application legibly and in its entirety. Illegible or incomplete applications will be rejected. Applicant must include a certified copy of the academic transcript with the application. Submit the completed application by the deadline of August 31st.

1. The applicant shall be a member in good standing as defined in the Association By-Laws.

2. The applicant shall be enrolled in a degree program related to environmental and public health. The degree program must be offered at a recognized and credentialed college, university or other institution of higher learning located in New Jersey, New York or Pennsylvania. The Committee may, by a majority vote, approve scholarships to applicants enrolled at approved schools outside of New Jersey, New York or Pennsylvania.

3. The applicant must complete an official Gary S. Strauss Scholarship Fund application in its entirety and officially submit it to the Scholarship Committee by the deadline of August 31st.

4. Applicants who have previously received this scholarship are ineligible.

5. Applicants seeking a scholarship to fund continuing education credits are ineligible.

Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you an Active Member (in good standing) of the New Jersey Environmental Health Association?

Current Occupation:

Please list your last (2) places of employment

List financial assistance from other sources (including loans, municipal, county or state funding):

Type of educational degree currently being pursued?

List the college, university, or institution of higher learning in which you are presently enrolled:

Date of enrollment:

Anticipated date of completion:

List approximate educational expenses peryear:

Tuition

Books

Fees

Other

List your academic objectives:

List any civic groups, associations or any other community organizations or activities of which you are a member. Also note any special honors or awards received.

Certification by applicant:

I hereby certify that the information provided in this application, which you are authorized to verify, is true and correct, and I agree to notify the grantor of this scholarship of any material changes in the facts stated in this application.

Signature

Date