MGMA, Mobile, AL Chapter Tuition Scholarship Application
Name of Scholarship: MGMA SCHOLARSHIP, Mobile, AL Chapter
Candidate Information:
Name:
________________________________________________________________________
Address:
________________________________________________________________________
________________________________________________________________________
Telephone: ______________________________________________________________
Facsimile: ______________________________________________________________
E-Mail: ________________________________________________________________
Do you have a family member associated with MGMA? ___Yes ___No
Relationship and name:
_______________________________________________________________________
Academic Institution:
Name:
________________________________________________________________________
Address:
________________________________________________________________________
________________________________________________________________________
Main Telephone: ____________________________________________________
Main Facsimile: _____________________________________________________
Main Web Site: _________________________________________________________
Intended Field of Academic Study:
______________________________________________________________________
Intended Degree:
_______________________________________________________________________
Expected Completion Date: __________________________
Intended Major:
_______________________________________________________________________
Intended Profession:
_______________________________________________________________________
Acknowledgment Statement:
I, ___________________________, state that all the information, stated above, and all
submitted supporting information, is correct to the best of my knowledge. I further state
that I accept the rights of the MGMA to award the scholarship to the candidate judged by
them to be the most appropriate candidate.
Signature: _____________________________________________________________
Date: _________________________
Mail applications to:
Scholarship Committee, MGMA, Post Office Box 161350; Mobile, AL 36616