Mail to: Application Deadline is June 1 |
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| Last Name | First Name | MI | |
| Address | City | State | Zip Code |
| Telephone number
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Fax number
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E-mail address | |
| Graduate Program in Rehabilitation Counseling | |||
| School | Program | Degree | Dates of Attendance |
| Program Advisor | Program Advisor's Telephone Number
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| Essay: (500 words or less. Attach more sheets if necessary.) Please describe your vision of the field of vocational rehabilitation and how you will contribute to the realization of your vision. | |||
Please attach:
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Mail the application form and all required attachments by June 1st to be considered for the scholarship for the following fall semester. The award is announced in July.
An interview with the Scholarship Committee is required for all scholarship finalists.