Health Ecology Supplemental Scholarship
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Please Note: Only Supplemental Scholarship Applications submitted between October 1st and February 1st will be accepted! Submissions between February 2nd and September 30th will be automatically discarded.

Full Name:
Email:
Student ID #:
Gender: Male Female
Date of Birth:
Race/Ethnicity:
Were you born in Nevada? Yes No
Did you graduate from a Nevada High school? If yes, name it:
Current Residency
(State and County):
Name of scholarship(s) for which you are applying:
Major:
Year: Junior Senior MPH Student
Current GPA:
Have you received any federal grants/loans/work study?
Do you have any special circumstances that you would like us to consider with your application (e.g., single parent, disabled, self-sufficient, etc.)?
What are your career interests (e.g., medicine, physical therapy, nursing, health education, working with people with disabilities, etc.)?
Briefly describe your previous work experience and volunteer work, including the age groups of those with whom you've worked (i.e., children, teens, adults, elderly):

If you are aiming towards a career that focuses on working with children, especially in the physical activity area, please describe, in 1 or 2 paragraphs, your work experiences with children and provide details about your future career plans


Please provide all methods of contact; cell phone, local address, etc.
Cell Phone (or other phone):
Address:
City and State:
Zip Code: