Former Recipient Survey
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Current or Permanent Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What high school did you graduate from?
*
High School Graduation Year
*
What college did you graduate from?
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College Graduation Year
*
College Major and Degree
*
If applicable, please list any other advanced degrees you've received and the school/program you received them from.
Current profession and place of employment
*
Please list any other positions or work experiences you would like to share.
How did receiving the Ella C White Memorial Scholarship help with your educational pursuits and life goals?
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What activities are you involved with in your profession or community?
What quote, book, role model/person, class, event, or experience has inspired you or has helped shape your life? How and why?
What advice do you have for high school students, recent college graduates, or donors?
Please share a professional horizontal photo. If you are taking a photo with your mobile device, please be sure it is clear and in the highest resolution. Because this photo will be shared with your profile in our direct mail campaign and on our website, please make sure you have a professional appearance.
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Consent: By providing information, you are giving consent to us to share your photo and information in our fundraising, public relations and awareness campaigns, including brochures, websites, videos, social media and other channels.
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Yes
Is it okay for us to contact you by phone or email if we need further information?
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Yes
No
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