GED Scholarship Application

*First Name:

*Last Name:

*Student Identification Number:

*Major/Area of Study:

*Street Address:

*City:

*State:

*Zip Code:

*Phone Number:

*E-mail Address:

*Date GED was completed:

*Overall GED Test Score:

*Signature: I affirm that all information supplied on this application is complete and accurate. If selected to receive a scholarship, I grant permission to UA-PTC to release scholarship award information to media outlets.

I understand that typing my full name in this box constitutes a legal signature confirming that I acknowledge and agree to the understandings above.

*Date: