NAHU Education Foundation

Applicant Information

Name
Date of Birth
SSN
Place of birth
Current address (no P.O. boxes)
City
State
ZIP Code
Home Telephone
Cell Number
E-mail
How many siblings do you have?
What are the ages of your siblings?
List several of your hobbies:

Education Information

Education status
Name of college or high school
School address
City
State
ZIP Code
Phone number
GPA

About Your Eligibilty and Qualifications

1. How old were you when your parent(s) or guardian(s) became seriously ill or disabled? (If this type of qualification does not apply to you, go directly to question 7)

2. Describe the financial impact on your family.

3. Did the disability or disease cause you to seek employment to help support yourself and/or your family? If so, please specify what kind of employment you sought (e.g., f/t, p/t, various jobs) and briefly describe the job(s) in no more than 140 characters.

4. Did your ill or disabled mother/father/guardian have health insurance? Yes   No

5. If "yes", how important were the benefits from your parent's/guardian's health insurance in helping keep your family's financial and college-funding plans on track?

6. Did your family have other kinds of insurance? Yes   No

7. If you are pursuing a career in insurance, which area of insurance are you interested in pursuing in your school, college or university?

8. What do you anticipate your major will be? List some of the courses you have taken or are registered for which will help advance you in your intended career.

9. List three reasons you believe insurance is important to American families:
a.
b.
c.

10. I will e-mail my video or written essay to education@nahu.org. Yes   No

Signature

By clicking "Submit Application" below, I swear and confirm that the information I have provided above is true and accurate to the best of my knowledge. I have read and agree to be bound by the scholarship rules and requirements. I hereby release and transfer all rights to the information contained herein and/or submitted with my application to the NAHU Education Foundation.