*Required field(s) are indicated by an .**
* First Name
* Last Name
* Major(s)
* Minor(s)
* Cumulative GPA - Based on a 4.0 scale
* Expected Graduation Date	/ / (MM/DD/YYYY)
* Telephone number
* Alternate Telephone
* Email address
Mailing address
City
State
Zip Code
* College/University You Are Attending
* City
* State
* Zip code
* Student Classification
* Gender: (To confirm hotel room assignments)	Male
	Female
Please list/ describe your extra-curricular/community activities.
In 100 words or less, please tell the HACU Student Track why you would like to attend the HACU 23rd Annual Conference. Please tell us what you would contribute to the success of the Student Track component.
Release	My information can be used for other HACU programs
	I only want to be considered for this scholarship
Scholarship recipients will be notified by e-mail at the end of July 2010. *IMPORTANT – It is your responsibility to notify HACU of any changes to your application information. Failure to notify Student Track of any changes will forfeit your scholarship if awarded.

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