ELLIOTT PRE-MED SCHOLARSHIP APPLICATION
Application must be submitted by 12:00pm, Friday, February 28, 2020.
No late applications will be accepted.
ALL requested information must be provided. Applications missing any required information will not be
considered. Please type or print legibly.
Name __________________________________________________ 900# ___________________________
Telephone _________________________ E-mail Address __________________________________________
Major ________________ Minor _____________ Classification ________ GPA _________ ACT __________
Expected Graduation Date _______________ Hours completed ___________ Hours enrolled in ___________
List all university biology, chemistry, physics, and mathematics courses you have completed and the grade
made in each course.
List any university awards or honors received based on academic performance.
List any organized extracurricular activities or work experiences in which you have participated at the
List scholarships (with dollar amounts) and any financial aid (with dollar amounts) that you are currently
Submit this form along with a 1 page essay stating your reasons for applying and your professional goals to
Barbara Knight, Walters 109 or by e-mail to firstname.lastname@example.org.
Signature _________________________________________________________ Date ______________