ETHEL LOUISE ARMSTRONG FOUNDATION (ELA)
SCHOLARSHIP APPLICATION FORM

Please note: all fields must be completed for the form submission to be successful and relevant toward your application.
First Name:
Last Name:
Age:
Specify Physical Disability:
I am a US citizen. yes  no

If no, I am a citizen of
Permanent Home Address
Street:
City:
State:
Zip:
Home Phone:
Mobile Phone:
School/Residential Address
Street:
City:
State:
Zip:
School/Res. Phone:
Email:
Personal/Business Website:
EDUCATION
Undergraduate Program
Undergraduate Degree:
Undergraduate Major:

Undergraduate School:

Cumulative GPA:
Graduation Date:
Graduate Program
Graduate Degree being pursued (Master's or above):

Major area of study:

Graduate School:

Address:
City:
State:
Zip:
Currently Enrolled:       yes  no
Entering Fall 2010       yes  no
Number of credit hours completed to date, if any
Cumulative GPA
Expected Date/Yr of Graduation
Academic Advisor's Name:

Phone:
Fax
Email:

Financial Aid Office Contact Name:

Address:
City:
State:
Zip:
Phone:
Fax:
Email:
OTHER
 
Are you a member of AAPD? yes  no
 
List college and community activities in which you have participated, stating position or office attained, if any.
List Disability organizations in your community in which you are a member.
Please specify your level of activity in the organization.
 
If selected as an ELA Scholar, will you participate in the ELA Scholar Listserv? yes  no

This Listserv was established by the ELA Foundation in order to provide a forum for ELA Scholars to discuss current issues and network with each other. Membership is by invitation only.