Anticipated total amount over the full term of this award.

$2,000.00

1. Spouse and/or Parent UNT Health Employee 8-digit ID# (This is NOT the EUID, which is letters and numbers)
2. Name, Department and Email of your spouse or parent that is a current, full-time employee at UNT Health.
   • Department of your spouse or parent that is a current, full-time employee at UNT Health.
   • Full name of your spouse or parent that is a current, full-time employee at UNT Health..
   • UNT Health email address of your spouse or parent that is a current, full-time employee at UNT Health.
3. Applicant's relationship to current full-time employee.
4. Please upload a marriage certificate if you are the spouse or a birth certificate if you are the dependent as proof of being the spouse or dependent of a current full-time UNT Health employee.
5. What certificate or degree are you pursuing?
6. Current Enrollment Status
   • Are you currently enrolled in at least six hours for the fall semester and taking courses that lead to a degree or certificate?
   • Please provide the number of credit hours in which you are currently enrolled for the fall semester.
7. Please upload a copy of the applicant's current transcript from their college, university, or high school.
8. Registration Payment Verification
   • If URL link cannot be provided, please provide an official copy of applicant's registration payment at the accredited college/university they are attending during the fall semester.
   • Please provide a URL link to a copy of applicant's registration payment at the accredited college/university they are attending during the fall semester.
9. Applicant GPA
   • Is your cumulative GPA a 3.0 or higher?
   • Please provide your cumulative GPA.
10. Has this applicant received this scholarship before?
11. For new students starting this summer or fall semester - What is your current GPA?
12. What are your educational and career goals and how will this scholarship help you achieve them?
13. Select one of the five UNT Health values you most closely identify with and share a story of how you live out this value.
14. By entering my name below, I certify that the information I have provided on this application for my spouse/dependent is true and complete to the best of my knowledge, and that if this application does not meet the standard General Academic Scholarship application criteria by the deadline this application will not be considered. I understand that the information utilized in determining my spouse/dependent’s eligibility (GPA, admission status, etc.) will be the information as it stands at the date of the application deadline. No updates or adjustments will be accepted after that point. I understand that the information about my spouse/dependent may be used to evaluate their eligibility for a scholarship, and I authorize the Scholarship Office to release information to the appropriate scholarship committees. If selected for a scholarship, I authorize release of my spouse/dependent’s information to be given to donors or used in publicity related to the scholarship program. I further agree that I will notify the Scholarship Office of any changes (residency, program change, etc.) which may affect my spouse/dependent’s eligibility for this award. Finally, I understand that the submission of false information is grounds for rejection of this application and/or withdrawal of a scholarship offer. I agree to abide by the policies, rules and regulations governing the University of North Texas Health Science Center. I CERTIFY that I understand the above information.
    • 1. Signature (Full Name)
    • 2. Date
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