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application - 2012 AVON REPRESENTATIVE SCHOLARSHIP PROGRAM...

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TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES Completeness and neatness ensure your application will be reviewed properly. Application postmark deadline February 1, 2012 I.D. # AA PD RIC/CS GPA SATCR SATM SATW ACTC TOTAL Last Name First Middle Initial Permanent Home Mailing Address Apartment # City State ZIP Code Telephone ( ) Email Address Date of Birth: Month Day Year Maiden Name (if applicable) Your Representative District Number: Account Number: I verify I am the Avon Representative applying for this scholarship. Please indicate your status. (For statistical purposes only) Male Female School Name Graduation Date: Month Year City State Telephone ( ) Name of postsecondary school you plan to attend. (If unknown, please list in order of preference the schools to which you have applied.) Use official school names. Do not use abbreviations. City State City State 4 yr. College or University 2 yr. Community or Junior College Vocational-Technical School Other, explain Enrollment Status: Part-time (less than 12 credits/term) Full-time (12 or more credits/term) Year in school next year: 1 2 3 4 5 or Graduate Study Major or course of study When do you expect to graduate? Month Year Degree sought: Certificate Associate Bachelor’s Master’s Ph.D. Other Sending a resumé does not replace any part of this application. If space provided in any section is inadequate, you may continue on additional sheets. Attachments must follow the same format. DO NOT repeat information already reported on the application form. Your name, address and name of this scholarship program should be included on all attachments.
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