Gin Sun Hall Benevolent Association

2013 Merit Scholarship Application

 { Note to applicants: Suggest you please print and use this form for your application }

PLEASE PRINT

甄 舜   

Gin Sun Hall Benevolent Association

2013 Merit Scholarship Application

 

SECTION A: (Applicant Information)

 

 

Name of Applicant:                English: _________________________________________

 

                                            Chinese: _________________________________________

 

Date of Birth: _____________________                         Gender:  ___  Male   ___  Female

 

Address: ________________________________________________________________

 

City/ State/Zip: ___________________________________________________________

 

Telephone: Home: (       ) ___________________      Cell: (        ) ___________________

 

E-Mail Address: __________________________________________________________

 

Name of High School ______________________________________________________

 

Address: ________________________________________________________________

 

College/University of Enrollment: _____________________________________________

 

Address: ________________________________________________________________

 

 

Signature of Applicant: ______________________________Date: ________________

 

 

 

SECTION B (Parentsí/Guardian Information)

 

 

Parentsí/Guardianís Name:         English: ______________________________________

 

                                                    Chinese: _____________________________________

 

Address: _______________________________________________________________

 

City/State/Zip: ___________________________________________________________

 

Telephone: Home: (       ) ___________________    Cell: (        )____________________

 

 

Signature of Parent/Guardian: ________________________Date:  _______________