2021 MDCD Scholarship Application

Applicant Personal Information

 
First
Middle
Last
Address
City
State
Zip Code
E-mail
Home Phone
Cell Phone
Date of Birth ?
Age
Date of Graduation ?
Overall GPA
Degree program or intended course of study
College or University (current or intended)
Mother First Name
Last Name
Father First Name
Last Name
Parent Employed by MDCD Member
Station/Company Name
Phone
How Long With Company
City

Applicant Employment History

Please list work experience, beginning with current or most recent employment, and include volunteer positions or internships.
 
Employer Name
Date of Employment ? to ?
List Job Responsibilities
Employer Name
Date of Employment ? to ?
List Job Responsibilities
Employer Name
Date of Employment ? to ?
List Job Responsibilities

Applicant Additional Information

 
Please list and briefly describe any awards, honors or recognition you have received
 
 
Please list extra-curricular activities you have been involved in, including leadership roles held.
 
 
Applicant Authorization
I authorize the use of my scholarship application in the evaluation process of the Maryland DC Delaware Broadcasters Scholarship Award Program. I declare that, to the best of my knowledge, the information provided on this form is correct and complete. I also authorize the release of publicity about me if I am the recipient of the scholarship.
Applicant InitialsDate ?
 
Parent Authorization
I, the parent of the scholarship applicant, declare that, to the best of my knowledge, the information provided on this form is correct and complete, and I certify that the information regarding my employment by a company that is a member of the Maryland DC Delaware Broadcasters Associations is true and correct. I consent to the use of the information provided on this form in connection with the scholarship program and consent to the release of publicity about my child if my child is the recipient of the scholarship.
Parent of Applicant InitialsDate ?
 

Please remember, scholarship application information must be emailed to Elizabeth Parker Harris by Friday, May 14, 2021.

   - denotes required fields