Osher Institute Scholarship Application

Scholarship Application

TODAY'S DATE:(Required)

YYYY

SCHOLARSHIP TERM:(Required)

Full Scholarship Option: Includes annual membership (value of $100) valid for one academic year, plus one free fee-based course each semester (value of up to $45 per course) and access to all other free and included programs and events. Partial Scholarship Option: $30 toward the annual membership fee. Payment for the remainder of the membership balance is due at the time of membership activation. Member receives programs indicated as “Included with membership” at no cost; programs with fees indicated are the responsibility of the Osher member.

Name and Contact Information

NAME:(Required)

First Last

ADDRESS INFORMATION:(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

EMAIL ADDRESS:(Required)

PHONE NUMBER:(Required)

Background Information

Please describe your interest in the Osher Institute.(Required)

Please briefly explain your financial situation in terms that allow the scholarship committee to understand your need for a financial scholarship. (Because fixed incomes vary widely, simply stating that you are on a fixed income is not sufficient.)(Required)

How many times have you received a FULL scholarship?(Required)

Once

Twice

Three times or more

I have not received a full scholarship in the past

How many times have you received a PARTIAL scholarship?(Required)

Once

Twice

Three times or more

I have not received a partial scholarship in the past

Age Certification

Financial scholarships are for individuals aged 50 and older whose financial situation precludes participation in the Osher Institute without scholarship assistance.(Required)

Please check to certify that you are 50 years of age or older at this time of your application.

Osher Institute Scholarship Application

Scholarship Application

Name and Contact Information

Background Information

Age Certification

Osher Lifelong Learning Institute