HBCU Week x AstraZeneca Scholarship Application for Existing Students

Page 1

Scholarship Eligibility

	Yes	No
Are you a U.S. citizen or legal permanent resident of the United States?

	Yes	No
Are you a college student?

Classification

*To be eligible for the scholarship, you must be a U.S. citizen or legal permanent resident of the United States.

*To be eligible for the scholarship, you must be a current college student.

Page 2

Student Information

First Name

Last Name

Date of Birth

Mailing Street

Mailing City

Mailing County

Mailing State/Province

Mailing Zip/Postal Code

Mobile Phone

College Email

	Email	Phone
What's the best way to contact you?

How did you hear about the scholarship?

Other

College Information

Current HBCU

College ID

Statement of Financial Need

I attest that I am in need of financial assistance for my college expenses

YesNo

Household Income

Please provide a Statement of Financial Need

(200 word maximum)

Current Major

College Grade Point Average

Page 3

Tell us about yourself

In a 2-4 minute video, tell us about yourself & why you need this scholarship. Please also highlight how the pharmaceutical industry can support underrepresented groups and increase trust? Be creative!

Best submission results are 720p (HD) resolution. File size limit is 35MB.

Tell us about yourself.

Why you need this scholarship?

If you were to be awarded this scholarship, what would you use the funds for?

How can the pharmaceutical industry support underrepresented groups and increase trust?

Share a 2 - 4 minute video

Letter of Recommendation

Please include one letter of recommendation from a trusted source who can highlight your passions and goals.

Letter of Recommendation

Most Recent Transcript

Most recent transcript

Page 4

ACKNOWLEDGMENT AND RELEASE

I have read and understand the criteria and requirements and agree to all. I understand that lack of fulfillment of these criteria may result in loss of the award.

As a condition of scholarship receipt, I give permission to HBCU Week Foundation to use my name, photos, video imagery, video audio, interview content and other materials about me for promotional, publicity, marketing, or organizational purposes.

STUDENT SIGNATURE IS REQUIRED ON THE FOLLOWING PAGE.