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KnowMS Scholarship Application

1. About You:

 

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Date of Birth:

 

 

 

 

What's this?

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Question - Required - What licenses do you currently hold? (Check all that apply)
Please make at least 1 selection from the choices below.

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(Maximum response 255 chars, approx. 5 rows of text)

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If you said yes to either of the questions above, we would like to learn more about the meeting you wish to attend. Please answer the following questions. If you said no to the questions above, please skip to question 10. 

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(Maximum response 255 chars, approx. 5 rows of text)

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Question - Not Required - If you said yes, please indicate which certification you are interested in from the list below:






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(Maximum response 255 chars, approx. 5 rows of text)

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(Maximum response 255 chars, approx. 5 rows of text)

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Question - Required - Should you be granted a KnowMS Scholarship, we ask that in exchange you continue to be a part of our chapter's mission. You will have ONE YEAR to complete your "gift of time" and you can satisfy this requirement in a number of ways. A chapter staff member will contact you to discuss your involvement interests and ensure you are matched with an activity most in line with your skills and interests. Please check the activities below that sound most appealing to you.
Please make at least 1 selection from the choices below.

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By submitting this form, you agree that within 1 year of receipt of your KnowMS Scholarship that you will fulfuill your "gift of time" commitment to the Greater Delaware Valley Chapter's mission. By submitting this form, you confirm your understanding and acceptance of the rules and conditions for application. The information in this application form is true and to the best of your knowledge.

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