A Registered 501(c)3 Public Charity

Amanda J. Mierzwa Memorial Fund

Name of the Memorial/Scholarship Fund for which you are applying:

Applicant's Name:

Applicant's Cell Phone:

Applicant's Personal Email:

Applicant's University of Michigan Email:

Applicant's Address:

Applicant's City:

Applicant's State:

Applicant's Zip:

High School From Which You Graduated:

Year of High School Graduation:

Why did you choose to attend the University of Michigan?

What is (or will be) your major at U of M?

What are your career goals?

Please list any extracurricular and/or service activities in which you have been involved.

If you are awarded this scholarship and someone asks you to explain who Amanda Mierzwa was, what would you say?

If you are awarded this scholarship, do we have permission to publish your name and some other information (eg., high school, major, etc) about you as the winner?

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