Osher Institute Scholarship Application

Information with an asterisk * is required.

TODAY'S DATE: * Required
MM slash DD slash YYYY
SCHOLARSHIP TERM: * Required
Name and Contact Information
NAME: * Required
First Last
ADDRESS INFORMATION: * Required
Street Address City State / Province / Region ZIP / Postal Code Country
EMAIL ADDRESS: * Required
PHONE NUMBER: * Required
Background Information
Please describe your interest in the Osher Institute. * Required
Please briefly explain your financial situation in terms that allow the scholarship committee to understand your need for a financial scholarship. (Because fixed incomes vary widely, simply stating that you are on a fixed income is not sufficient.) * Required
Age Certification
Financial scholarships are for individuals aged 50 and older whose financial situation precludes participation in the Osher Institute without scholarship assistance. * Required
- Please check to certify that you are 50 years of age or older at this time of your application.

Name and Contact Information