Melba Priestley Memorial Scholarship Application

Name *

First

Last

Email *

Confirm Email

Home Address *

Zip Code *

Home/Cell Phone Number *

Work Phone Number

Birthdate *

Entered as MM/DD/YYYY

Birthplace *

High School Name *

High School Address *

Name of College/University *

College/University Address *

High School Honors and Awards Received *

What will be your college/university status in fall semester? *

College/University/Professional/Community Activities *

Why should you be chosen for this scholarship awarded by other educators? *

Is there anyone in your family who is a member of Alpha Delta Kappa? *

If so, what is the relationship?

Optional: Other information you would like to have considered.

How did you learn about the scholarship? *

By checking below, this serves as your legal electronic signature as the applicant for the Melba Priestley Memorial Scholarship.

I wish to be considered for the Melba Priestley Memorial Scholarship and this serves as my electronic signature