Scholarship Application


(Please Type Your Information, and Then Print This Page)

Last Name
First Name     Middle
Social Security Number
Home Phone #
City          State
Zip Code
Cumulative GPA   
Name of College/University


Mail To:

Angela Alonzo, Senior Special Agent

2003 HISLEA Scholarship Committee Chair

P.O. Box 470086

Chicago, Illinois  60647-0086


Telephone 312-385-1776 X2199 or 312-446-7132

Copyrightę 2002 HISLEA. All Rights Reserved.