Application for the Kershner Scholar Award |
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| Chapter |
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| Please select the school term for the data being reported. We must know the school term being reported for the application to be valid. |
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| Term |
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| Current Chapter Mailing Address |
| Street Address: |
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| City: |
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| State: |
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| Zip: |
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| Chapter Phone: |
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| Chapter President: |
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Director of Academic Affairs:
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