Essay Contest Application Form

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ESSAY CONTEST APPLICATION FORM
Full Name: _________________________________________________________________________________
Mailing Address: ____________________________________________________________________________
Email Address: _____________________________________________________________________________
Telephone Number: _________________________________________________________________________
Name of College/University: ___________________________________________________________________
Class (Freshman, Sophomore, etc.): _____________________________________________________________
What drew you to this scholarship contest?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
In your opinion, what is the best way to raise awareness of the dangers of alcoholism?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
By entering this essay contest, I warrant that I meet the following eligibility requirements:
(1) I am at least 18-years-old or older; (2) I am an undergraduate or graduate student who is currently enrolled in a college or
university located within the 50 United States or the District of Columbia; and (3) I have read and understand the
Scholarship Rules and Regulations and understand I am legally bound by them.
Signature:
Please sign and return this application by email to
Please Print Name:
Date:
Keep a copy for your records.

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