Trey Kertz Scholarship Application

If you see this don't fill out this input box.

*Name

*CWID

*Address

*City, State, Zip

*Email

*Phone

*Major

*Grade Level

FreshmanSophomoreJuniorSenior

*Please write a short essay on how cancer has directly impacted you and/or how you have been directly impacted by cancer. (maximum 300 words)

*How will this money be used?