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Maryland House of Delegates Scholarship Application

Basic Information

Are you a high school senior?: *

Are you a resident of District 31B? If unsure, please visit www.mdelect.net.: *

Level of education you are pursuing for the 2020-2021 school year?: *

Entrance Year: *

First Name: *

Middle Initial:

Last Name: *

Home Address: *

City: *

State: *

Zip: *

Home Phone:

Work Phone:

Cell Phone:

Date of Birth: *

Email Address: *

Education

College Name:

High School (if currently attending):

Specific Information

What is your one college of choice you wish to attend?: *

Must be a college/university within the State of Maryland. Exceptions only for majors not offered in this State. Student must apply for Unique Major status through MHEC.

Attend Year: *

Attend Level: *

Field(s) of Interest: *

Financial Needs

If applicable, please briefly explain any financial burdens on you or your family at this time that may help us in determining your financial need for the Maryland House of Delegates scholarship.:

Other Information

In 500 words or less, please explain your educational and professional goals and state how your college experience will contribute to the accomplishment of these goals.: *

In a sealed envelope, please include a letter of recommendation from one of the following: teacher, principal, guidance counselor, employer or respected community leader. Please send sealed envelope to:

Delegate Nic Kipke
Scholarship Committee
6 Bladen Street
Room 212 Lowe House Office Building
Annapolis, MD 21401

Electronic Signature: *

Type your full name.

Signature Date: *

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Maryland House of Delegates Scholarship Application

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Contact Del. Nic Kipke