I have read and understand this application. To the best of my knowledge, the information contained herein is true and complete. The Health Foundation Scholarship Committee has my permission to contact the school, persons or organizations and employers named in this application or such other sources as the Scholarship Committee may deem necessary for consideration of an award to me.

I understand any information contained herein discovered to be false or deliberately misleading will result in the removal of this application from consideration.

If I am granted a scholarship, I authorize the university/college I attend to release my grades each semester to the Health Foundation Scholarship Committee for the purpose of ascertaining my eligibility to receive the subsequent scholarship installment.