Congressman John Lewis Memorial Scholarship

Personal Information

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Country

Email*

Phone*

Semester you intend to start*

Class*

Scholarship Information

Are you classified as an under-represented minority in the medical field (African American, Native American, Hispanic American, etc.)?*

Are you a U.S. citizen or permanent resident?*

Please submit your proof of U.S. citizenship or permanent residence.*

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Was your cumulative undergraduate GPA a 3.0 or higher? Please have your official transcript sent directly to Xavier for verification.*

If yes, what was your cumulative undergraduate GPA?*

What school did you receive your undergraduate degree from?*

Please submit a personal essay (no more than 600 words) about how you intend to further John Lewis' legacy of fighting inequalities in your professional and personal life.*

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Acknowledgment

I have read and acknowledge the scholarship terms above and understand that a scholarship is not guaranteed to be given to me and may be revoked if terms are not met.

Signature*

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