Alexander House Scholars Application
Application for Alexander House Scholar candidates
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Full Name *
Current Address *
Permanent Address (if different then your current address)
Phone 1 *
Phone 2
Email (checked frequently) *
Social Media Platform(s) (used most frequently) List up to three *
Username(s)/handle(s)/etc of most frequently used social media platform(s) listed above *
Date of Birth *
MM
/
DD
/
YYYY
Sex/Gender *
Ethnicity *
Name of institution you plan to attend for academic year 2024/2025.  If you plan to be an intern or apprentice please note the organization you will be learning/training under.  If you plan to be a non-student please respond "non-student"  *
Will you be a full time or part time student for academic year 2024/2025?  Full time = 12 or more credit hours per semester;  Part time < 12 credit hours per semester *
Selected or anticipated program of study and/or general area of learning for internship/apprenticeship.  (Non-students type "Non-student" and area(s) which you are currently employed) *
Anticipated graduation or anticipated completion of course/internship/apprenticeship - Month/Year.  (Non-students type "Non-student") *
Do you have any health conditions that would restrict or limit your full participation in the Alexander House Scholars program?  List any health concerns or conditions or special needs (allergies, asthma, seizures, or other medical conditions, plus any dietary limitations/restrictions, etc.).                                                       *
Would you be interested in learning more about the possibility of sharing a room at the Alexander House with an assigned roommate for up to $500.00 in additional savings?   *
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