KMEF Scholarship Application Form

Please review the contents of the form below and prepare all necessary information BEFORE you begin to filling out the application.

Provide the requested information no later than June 30.

Mentor Information:

Last Name*
First Name*

Student Information:

Last Name*
First Name*
Middle Name
Date of Birth (mm/dd/yyyy)*
Email Address*
Address 1*
Address 2
Telephone (xxx-xxx-xxxx)*
U.S. Citizen?*
Yes   No   
If yes, choose which one.
Native    Naturalized    

Have you ever been put on probation, suspended or dismissed from any institution of learning for any reason?*
Yes   No   
If yes, please explain.*

Have you been convicted of a crime? (Do not list minor traffic violations or fines for parking tickets).*
Yes   No   
If yes, please explain.*

Secondary Education (High School):
High School Name*
High School Status*
Standardized Test:*
Math Score*
Verbal Score*

Post Secondary Education (College):
College Name*
Level of School in the Fall*
Will you attend next semester?*
Yes   No   
Are you currently living with parents, spouse or legal guardian?*
Yes   No   
Do you live on campus?*
Yes   No   
Have you declared your major?*
Yes   No   
If so, what is your major?
If not what do you intend declare?
Will you graduate this year?*
Yes   No   
If not, anticipated degree month and year (mm/yyyy)
Current GPA*

Extracurricular Activities:
Religous Group(s)?
Civic or Community Group(s)?
Atheletic activities?

Financial Aid:
Years you have received this scholarship*
Employment Status*
Have you applied for financial aid?*
Yes   No   
How much financial aid have you been awarded?
Tuition Costs*
Room and Board Costs*

Please email your photo, essay, transcript and FAFSA forms to
Also, please remember to have your letter of verification and three letters of reference emailed to

I hereby apply for the Katherine Murriel Education Fund, Inc., Scholarship Award. I certify that to the best of my knowledge and belief, all of the above statements are correct, complete, and are made in good faith. Consequently, I understand that any information contained herein found to be untrue, incomplete, and not made in good faith will cause my application to be discarded for consideration of a KMEF Scholarship award. Further, I understand that if I am receiving KMEF Scholarship fund but am found to have knowingly given false information on this scholarship application, any further funding shall cease to me, and I may be ineligible for consideration for any other financial aid from the Katherine Murriel Education Fund, Inc.
Please certify.*

I authorize my school to release any data from this form to the KMEF Scholarship Committee. I authorize the KMEF Scholarship Committee to use data from this application in public relation campaigns. My award check(s) may be made co-payable to my school and me. I hereby authorize the school to pay to me the amount of any scholarship awarded to me. I further authorize any school that I may attend to release to the KMEF, Inc. U.S. Department of Education or their agents, any requested information pertinent to this scholarship (e.g. education status, employment status, and current address). I certify that the proceeds of any scholarship made as a result of this Application will be used for educational purposes at my school in the period for which the scholarship is awarded. In the event I decide not to enroll in a University or College, I agree to return 100% of the scholarship to Katherine Murriel Education Fund, Inc..
Please certify.*