Scholarship Application Scholarship Application Note: Applicants may apply for up to four (4) scholarships and/or Grant-in-Aid opportunities.A maximum of two (2) total opportunities will be awarded.The applicant is responsible for ensuring eligibility information and support documentation is provided at the time of application.Failure to provide proper eligibility documentation at the time of application could be result in invalidation of your application.Applicants must also complete the FAFSA and other Financial Aid documentation. Your Information First Name Last Name Email Phone CountryPlease select... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe Date of Birth: MonthPlease select... January February March April May June July August September October November December DayPlease select... 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YearPlease select... 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Last Four Digits of Social Security Number Program you are applying for or completingPlease select... M.S. Psychology Psy.D., Clinical Psychology M.S. Counseling Scholarship Consideration Please select options all that apply to you. I am aPlease select... New Student Current Student I would like to apply for:Newman ScholarshipFaith and Hope ScholarshipPublic Servant ScholarshipInternational Student ScholarshipChristendom Scholarship I would like to apply for:Newman ScholarshipFaith and Hope ScholarshipPatriot ScholarshipPublic Servant ScholarshipInternational Student ScholarshipChristendom ScholarshipDiversity ScholarshipMatching ScholarshipGrant in Aid Scholarships for specific programsPsy.D. ScholarshipM.S. in Counseling ScholarshipPsy.D. Transfer ScholarshipSt. Ireneaus ScholarshipThelan EndowmentSt. Martin de Porres ScholarshipRegnum Christi/Legion of Christ Scholarship Early Admissions ScholarshipI am an Early Admissions Applicant Diversity Scholarship Information Highest Level of Education Completed by Father/GuardianPlease select... Master's/Ph.D./M.D./J.D Bachelor's Degree from U.S. College/University Bachelor's Degree from country outside U.S. Some college/Associate's Degree High school/GED Did not graduate high school Unknown Highest Level of Education Completed by Mother/GuardianPlease select... Master's/Ph.D./M.D./J.D Bachelor's Degree from U.S. College/University Bachelor's Degree from country outside U.S. Some college/Associate's Degree High school/GED Did not graduate high school Unknown Race / Ethnicity You are encouraged to supply this information. However, you may decline without compromising your application. Please check all that applyA - AsianPI - Pacific IslanderH - Hispanic/LatinoI - American IndianME - Middle EasternerB - Black (non-Hispanic)W - White (non-Hispanic)O - OtherD - Declined to Respond Disclosure I, the applicant, declare under penalty of perjury that the information provided on this application is true to the best of my knowledge. I have read and agree to abide by Scholarship eligibility requirements and all terms and conditions of DMU Scholarship Program. Date Yes, I certify that the information provided above is true and correct to the best of my knowledge. *Please note that in order for your application to be completed, you must submit all documentation required by the specific scholarships for which you are applying to financialaid@divinemercy.edu. Awards will not be considered until your complete application is received by the Office of Financial Aid at DMU.