ETHEL LOUISE ARMSTRONG FOUNDATION, INC. (ELA)
SCHOLARSHIP APPLICATION FORM
Name
First Middle Last
Age
Physically Disabled: yes  no  specify
I am a US citizen. yes  no If no, I am a citizen of
Permanent Home Address
 
  City State Zip
Home Phone Cell Phone
School/Residential Address
 
  City State Zip
School/Res. Phone
Email
Personal/Business Website
EDUCATION
Undergrad. Program
Undergrad. Degree
Undergrad. Major
Undergraduate School
Cum. GPA
Grad. Date
Graduate Program
Graduate Degree being pursued (Masters or above)
Major area of study


Graduate School
  Address
 
  City State Zip
Currently Enrolled       yes  no Entering Fall 2008       yes  no
Number of credit hours completed to date, if any Cum. GPA
Expected Date/Yr of Graduation
Academic Advisor's Name
  Phone Fax
  Email

Financial Aid Office Contact
  Address
 
  City State Zip
  Phone
  Email
OTHER
Where did you learn about the ELA Scholarship?
Do you currently belong to any Disability Listservs? yes  no
If Yes, which ones?
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
Are you currently a member of the American Association of People with Disabilities (AAPD)? yes  no
If you are not a member of AAPD, would you like to receive membership information? yes  no
If selected as an ELA Scholar, would you be willing to participate in the ELAScholar Listserv? yes  no

(This Listserv was established by the foundation in order to provide a forum for ELA Scholars to discuss current issues, network with each other and the Chair/Founder, the Board of Directors, and staff. Membership is by invitation only).