Scholarship Application

Please fill out the application below as completely as possible to help in the evaluation process. Required fields are marked with an asterisk (*).

Scholarship winners will be notified by e-mail and phone in early May upon completion of the evaluation process. Any correspondence will be sent to the address provided on the application unless other instructions are indicated.

For more information, contact the CDH Auxiliary at scholarchair@cdh.org.

Applicant Information
*First Name:
Middle:
*Last Name:
*Birthdate:

Applicant Contact Information
*Street Address:
Address 2:
*City:
*State:
*Zip:
*Email Address:
*Telephone:

High School Information
*Name of High School:
*Year of Graduation:

College Information
Name of College:
Major and/or Degree:
Year of Graduation:
Have You Been Accepted for next year?:	YesNo

Name of Post Graduate School:
Major and/or Degree:
Year of Graduation:
Have You Been Accepted for next year?:	YesNo


*Scholarships, grants, loans and other monetary awards applied for or already received (List amounts and explain):

*School and community activities (include honors and awards):

*List jobs you have held (indicate full-time, part time, or volunteer):


School to receive funds
Street Address:
Address 2:
City:
State:
Zip:

The information on this application is, to the best of my knowledge, complete and valid.
I plan to complete my intended course of study. I hereby wave any confidentiality with
respect to the above information insofar as the CDH Auxiliary is concerned since it is my
understanding that the information will be used soley for the purpose of evaluation of my
application for a scholarship.

*Please type in your initials to confirm you understand the preceding text:

* Indicates a required field

Please click the 'Submit' button only once