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Haberman-Williams MaMHCA

Scholarship Application

2015-16 Scholarship Year

Application instructions:

1. Please complete all sections of the application form.

2. Obtain an official copy of a transcript from the most recent academic work (undergraduate or graduate).

3. Write a biographical statement (two typed, double-spaced pages). Essay must address career goals, interests, and work, volunteer, and/or school/field experience relevant to the guidelines of the award.

4. Obtain two letters of support from professional references.  Letters should be written by a candidate's professors or practicum/internship supervisor.

5. Please submit all information together and mail it to:

Haberman-Williams MaMHCA Scholarship Committee

c/o MaMHCA

17 Cocasset Street

Foxboro, MA 02035

|Name: |

|Address: |

|City: |State: |Zip: |

|Phone: |E-mail: |

Education

|University/College: |Degree Program: |

|Student Status: FT ___ PT ___ |Projected Graduation (mm/yy): |

|Credits Earned to date: |Practicum site (if applicable): |

|Internship Site (if applicable): | |

Employment

|Employed: Not applicable ___ FT ___ PT ___ |

|Employer: |

MaMHCA Membership (required to be eligible for award)

|Member of MaMHCA? Yes ___ No ___ |

MaMHCA Board of Directors Commitment

|I agree to participate in MaMHCA Board of Directors Meetings during my scholarship year. |

|Yes ___ No ___ Signature: ________________________________________________ |

Application Checklist

Please be sure to include the following with your application:

____ Official transcript

____ Biographical statement

____ Two letters of support from professional references

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