Scholarship applications are due on March 15, 2020.

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Personal Information

Name (Last, First M.)

M#

Address

City

State
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Zip Code

County

Telephone

Email Address

Date of Birth

Parent / Guardian Name(s)

Is this a single parent household?
Please Select Yes No
Ethnicity

Caucasian

African-American

Hispanic

Other

Birthplace

Are you a U.S. Citizen or Permanent Resident?
Please Select Yes No
Parent / Guardian Address

Educational Background Information

High School Attended

Date of High School Graduation

College Attended

Date of College Graduation

High School GPA

ACT/SAT Composite Score

High School or College Community Activities, Leadership Roles, and Personal Involvement

College Major

Student Level
Please Select Undergraduate Graduate
Hours toward graduation

College GPA

Work Experience

Honors, Recognition, and Awards Received

Have you previously received an ET departmental scholarship?
Please Select Yes No
If so, which one & which semester/year?