1. Are you a United States citizen or legally living permanently in the United States? Yes No

2. Are you diagnosed with an inherited bleeding disorder? Yes No

3. Have you performed unpaid community service and/or volunteer work with any organization, not associated with school? Yes No

4. In the fall of 2025, will you be entering or attending an accredited two-year or four-year undergraduate institution in the United States to obtain your first undergraduate degree? OR In the fall of 2025, will you be entering or attending an accredited four-year undergraduate institution in the United States to obtain your first Bachelor's Degree after obtaining your first Associate's Degree? Yes No

5. Are you a past recipient of a Beth Carew Memorial Scholarship? Yes No

6. How many Beth Carew Memorial Scholarships have you been awarded? 1 2 3 4