Scholarship Application Form

This part is to be completed by Sponsoring Chapter member

Chapter Name:

Date:

Name of Sponsoring Member:

This part is to be completed by Applicant
Name:

Date of Birth:

Your E-Mail Address:  
Permanent Mailing Address:
Name of School Attending :
Address of school:
Courses Studied:

Date you will receive diploma : Grade Point Average: Class Rank:

Activities you participated in at School:

School sports or other activities:

Enumerate any Honors or Awards received:

College you plan to attend, or are attending:

School Address:

Date of entry:

Major Selected:

Two References (Names and Addresses) 

Name of Parent or Guardian:

Is a member of your family, a member of the
Thermopylae Chapter #445 Order of AHEPA?  yes no
Is a member of your family a member of any other
Order of AHEPA? yes no

What Chapter?

The Thermopylae Scholarship Committee will review all information.

Date:   Signature of Applicant:

TO BE ELIGIBLE FOR THE SCHOLARSHIP, THE APPLICANT MUST BE A DELAWARE
COUNTY PENNSYLVANIA, RESIDENT. AND MUST BE SPONSORED BY AN  AHEPA  MEMBER OR FAMILY MEMBER WHO IS IN AHEPA