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MARY ELIZABETH ADAMS ENDOWED SCHOLARSHIP APPLICATION To be considered for this scholarship you must be currently enrolled in or admitted to a degree-granting program at UAB. Please mail your completed scholarship application and all supporting material to UAB OFFICE OF STUDENT FINANCIAL AID HUC 317 1720 2ND AVENUE SOUTH BIRMINGHAM AL 35294-1150 NOTE Priority consideration is typically given to undergraduate students who are planning to pursue a degree in the sciences or who have declared a pre-medicine track. be a U*S* citizen and a resident of the state of Alabama* enclose a one-page essay describing your career goals and why you have chosen your particular field. Please include your name and student ID number at the top of the page. ATTACH A PHOTOGRAPH OF YOURSELF HERE* OPTIONAL self identify as having type I diabetes and provide a written statement from your physician or health care provider confirming the condition* All materials must be received by the Office of Student Financial Aid no later than 5 00 p*m* on Friday November 16 2012. FOR OFFICE USE ONLY Complete Recommendations Essay Transfer GPA UAB GPA Overall GPA Current UAB Scholarships Considerations Offers PLEASE PRINT Student ID Number B Male Female Race Birth Date Issued at time of admission to UAB First Name Last Name Middle Preferred First Name Email Address Apt County State High School Attended High School Graduation Date mm/yy Major Zip Code uab. edu City Phone High School City and State Expected College Graduation Date mm/yy Please list the following information for all colleges that you have attended including UAB Name of college/univeristy Start Date mm/yy End Date Degree Earned Leadership Positions Club Memberships and Honors Received high school and college List your employment history to date if any List any volunteer activities Other information you consider important Do you intend to apply for federal financial aid for the upcoming academic year Marital Status Number of Dependents Yes No Are you a U*S* citizen Annual estimated family income Number of persons being supported by this income including yourself I grant permission to release information from my educational and financial records to scholarship donors. If awarded a scholarship I grant permission to UAB and the Department of Labor to issue press releases. be a U*S* citizen and a resident of the state of Alabama* enclose a one-page essay describing your career goals and why you have chosen your particular field. Please include your name and student ID number at the top of the page. ATTACH A PHOTOGRAPH OF YOURSELF HERE* OPTIONAL self identify as having type I diabetes and provide a written statement from your physician or health care provider confirming the condition* All materials must be received by the Office of Student Financial Aid no later than 5 00 p*m* on Friday November 16 2012. FOR OFFICE USE ONLY Complete Recommendations Essay Transfer GPA UAB GPA Overall GPA Current UAB Scholarships Considerations Offers PLEASE PRINT Student ID Number B Male Female Race Birth Date Issued at time of admission to UAB First Name Last Name Middle Preferred First Name Email Address Apt County State High School Attended High School Graduation Date mm/yy Major Zip Code uab. edu City Phone High School City and State Expected College Graduation Date mm/yy Please list the following information for all colleges that you have attended including UAB Name of college/univeristy Start Date mm/yy End Date Degree Earned Leadership Positions Club Memberships and Honors Received high school and college List your employment history to date if any List any volunteer activities Other information you consider important Do you intend to apply for federal financial aid for the upcoming academic year Marital Status Number of Dependents Yes No Are you a U*S* citizen Annual estimated family income Number of persons being supported by this income including yourself I grant permission to release information from my educational and financial records to scholarship donors.