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Litzenberg Memorial County Hospital

Litzenberg Auxiliary Scholarship Application

OFFERED BY LITZENBERG HOSPITAL AUXILIARY FOR 2014

SCHOLARSHIP APPLICATION FOR CENTRAL CITY AREA HIGH SCHOOL SENIORS
(Requires a Merrick County address or requires that you are attending a Merrick County school)
* Name
* Birthday
* Gender Male     Female    
* Street Address 1
  Street Address 2
* City
* State
* Zipcode
* Current Phone Number
xxx-xxx-xxxx
* Parent's Name
* High School
Name and Address of college or school you are planning to attend
* Name of College/School
* Address
* Have you been accepted? Yes     No    
* Have you applied for financial aid? Yes     No    
Attachments
* Upload Your Cover Letter ( preferred format: .doc or .pdf )
A cover letter is required to be submitted with this application. Please include your school and community activities and tell us about your goals for your future education. Tell us about your work experience, if applicable and your scholastic achievements.