Gregory W. Gile Scholarship Application

For High School Seniors or Established and Continuing College Students with Epilepsy

Please print or type and answer all questions carefully.
Use additional sheets of paper if necessary.
(Please note this is not an online form - print out this blank form)

Applicant's Name (Last, First, Middle)	Phone Number
Address (Street, City, Zip)	Email Address
Parent/Guardian Name	Phone Number
Address (Street, City, Zip)	Email Address
Social Security Number Birth Date Birth Location U.S. Citizen or Permanent Resident? Yes No
High School Attending/Attended Have you applied for or received any other scholarships? Yes No
High School Address (Street, City, Zip)
College Attending
College Address (Street, City, Zip)
(Signature verifies that the information provided is accurate and any false information given shall be considered cause for rejection of this application.)
_______________________________________________ Signature of Applicant __________________________ Date

Application Deadline: March 15, 2008
(Must be received by March 15, 2008)

Return Form To:

Epilepsy Foundation of Idaho 310 West Idaho Street Boise, Idaho 83702

This application form and other listed documents must be submitted by the application deadline in order to be considered for the GREGORY W. GILE MEMORIAL SCHOLARSHIP. Incomplete applications will not be considered.

Application Instructions| Physician Statement
Gregory W. Gile Scholarship | Previous Scholarship Recipients

Return to EFI Scholarship Info. | Return to EFI Main Page

Epilepsy Foundation of Idaho
310 West Idaho
Boise, Idaho 83702
(208)344-4340
epilepsyidaho.org