Application — Eileen Pollack Silverman Legacy Scholarship

THE APPLICATION

To apply, please fill out the following application fully and honestly. To first check that you qualify for the scholarship, visit the Scholarship page. For any issues, please email us directly here.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Number

(###)

###

####

High School Name

Please enter the full name of the high school you attended

Possible College Choices

Please include up to 5 possible colleges

In 500 words or less, briefly tell us about yourself

What are your hobbies and interests? Do you have any academic or life goals? What is your proudest achievement?

In 500 words or less, briefly tell us why you are a good candidate for this scholarship

As much as you feel comfortable, tell us how you or a family member has treated a medical condition with alternative therapies.

How did you hear about the Scholarship?