Name (first and last):


Email Address:

Phone Number:


Street Address:

City:
State: Zip:


Date of Birth (mm/dd/yyyy)

If appropriate - You are currently enrolled in a 2 year or 4 year program at this accredited Minnesota school:

If appropriate - You have been accepted and you have responded to the school indicating that you will be attending this accredited Minnesota school and plan on completing a 2 year or 4 year program:

If you completed the above entry please enter the start date of your first classes (mm/dd/yyyy):

By pressing the "Sign Up" button below, you certify that you have read the scholarship details page and you are in complacence and agree to the terms of the details page. To review the details page again click here (opens a new window).

Enter the code shown in the image: