HETRA University Scholarship Application
First Name
*
Last Name
*
Phone number
*
Email
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Program affiliated with, or future program affiliation:
Annual budget of center, if applicable:
Based on the value of the program or conference you are applying for, what do you think you could reasonably afford?
*
Please list any special circumstances we should take into consideration when determining your scholarship level. (500 characters)
*
Thank you for taking the time to complete this form. A member of our staff will review this information and get back to you as soon as possible.
Submit
Should be Empty: