Enzweiler Building Institute Scholarship Application
Part 1: Personal Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County of Residence
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Race
*
Field of Study
*
Campus Location
*
Part 2: Academic Information
High School Attended
*
Graduation Year
*
Do you have KEES money?
*
Yes
No
If yes, how much?
*
Do you have any other scholarships?
*
Yes
No
If yes, what scholarship and how much?
*
Part 3: Financial Information
Employer
*
Hourly Wage
*
Household Yearly Income
*
Number of Dependents
*
Are you eligible for any of these benefits (check all that apply)
*
Housing Subsidies
Social Security
SNAP
TANF
Medicaid
Head Start
CHIP
Disability Benefits
Other
Part 4: Scholarship Information
What are your career goals and how will an EBI education help you reach your goals?
*
Why is this scholarship important to you?
*
What other information about you should the scholarship committee know when considering you for this scholarship?
*
Part 5: Declaration/Re-Payment Waiver/Photo Consent
I hereby declare that the information provided in this scholarship application is true and accurate to the best of my knowledge. I understand that providing false information may result in the revocation of any awarded scholarship.
*
I declare
I understand that if I fail to successfully complete the program, I will be responsible for repaying any scholarship money I am awarded.
*
I understand
If selected as a scholarship recipient, I consent to being photographed as an award winner.
*
I consent
Signature
*
Date
*
-
Month
-
Day
Year
Date
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