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* 1. First Name

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* 2. Last Name:

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* 3. Company Name

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* 4. Address

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* 5. City, State/Zip

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* 6. Email

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* 7. Mobile Phone:

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* 8. Date of Birth

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* 9. Marial Status

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* 10. Date of Submission

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* 11. Employment History: List your employers for the past five years beginning with your present and most recent employer. Please designate part or full time for each position. Use the following format for each position: Employer, Position, and Duties and Dates of Employment

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* 12. Current Education: Which type of school do you presently attend?

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* 13. Future Education: Which type of school will you be attending next fall?

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* 14. Future Education: What will your academic standing be Fall 2024?

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* 15. Completed Education: Please list your high school with graduation date and final GPA, college with graduation date and final GPA and graduate degree(s) with graduation date and final GPA (as applicable).

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* 16. Post Graduate Continuing Education: Please list any applicable coursework.

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* 17. Activities: List your current community or extracurricular activities.

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* 18. Honors: List any academic honors you have received.

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* 19. Leadership: List any office or other leadership positions you have held

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* 20. Describe the educational program for which you are seeking this scholarship: Include the name of the institution or organization sponsoring the program, the subject matter or area of study, how long it will take to complete, the cost of the program and whether any degree or certificate will be awarded upon completion. You may provide a link to the website for the program or the sponsoring institution if you would like to.

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* 21. Application Reasons: What are your reasons for applying for this scholarship and why do you believe it should be awarded to you?

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* 22. Future Goals: What are your goals for the first five years after earning your degree?

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* 23. Describe your income for one year

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* 24. Describe your expenses for one year below:

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* 25. Are you eligible to receive financial assistance from any other source for any of the expenses to be incurred in this educational program? Yes Or NO, If so, give the amount of financial assistance in dollars $.

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* 26. What is your parents'/guardians' income?

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* 27. Member Sponsor: Include the name of your NCPMA member sponsor, company, address, email and phone. This information will be used to contact them and verify that they support this application.

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