2019 Karen Evans Scholarship Award

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Completion of this form indicates interest in being considered for Ohio SOPHE's 2019 Karen Evans Scholarship Award for graduate and undergraduate students of health education programs within the state of Ohio.

After completing this form, send an official/unofficial academic transcript and a letter of recommendation from a health education faculty member to Grant Seredick at grant.seredick@gmail.com.

Applications must be received by 5pm on Monday, September 30th, 2019.

Application Data

(Ohio Residents Only)

First Name *

Last Name *

Middle Initial *

Current Street Address *

City *

Zip *

Permanent Street Address (if different than previously listed)

City

Zip

Telephone Number *

E-Mail Address *

Are you currently an Ohio SOPHE chapter member? *

Yes

Employment Status *

Full-time

Part-time

Not currently employed

Employer

Position Title

Volunteer Activities and Years Involved: *

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