Mark Hauser Scholarship Online Application

Student's Full Name (required)

Student's DOB (required)

Address(s) (required)

Parent(s) Full Name(s) (required)

Phone Number

Email Address (required)

For which program/sport are you requesting a scholarship?

Have you received a scholarship in the past? (If so, when?)

In the space provided below, please describe the need for a scholarship.
(Requests for scholarships will not be considered without providing supporting information)

I hereby certify that the information provided above is true and accurate to the best of my knowledge.
By checking the box below, you are providing your digital signature. Your IP address and user agent will be submitted with the form.
Digital Signature