Alaska Medical Assistant Society State Scholarship or Anchorage Chapter of Medical Assistants Scholarship

Financial Information Page

In order for the Scholarship Committee to determine financial need we ask that you fill-out and sign this financial information page. This completed page is to be turned in with the rest of your application package.

Please indicate in the boxes below what current annual income level your household falls under. All information will be kept confidential and only the members of the Scholarship Committee will use this information.

If you have special financial needs we would encourage you to let the Scholarship Committee know about them. A space is provided for an additional explanation of financial need. This is optional.

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Name____________________________

Address_________________________________________________________________

Phone____________________________

Email____________________________

 I, ____________________________, agree that the financial information given above is true to the best of my knowledge. I acknowledge that all information submitted in this Anchorage Chapter of AMAS Scholarship package is my own information and is true to the best of my knowledge. I also acknowledge that the essay submitted was of my own composition.

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Signature of Scholarship Applicant                                 Date