2016 MILITARY ORDER OF THE PURPLE HEART SCHOLARSHIP APPLICATION PACKAGE GENERAL INFORMATION

I request and authorize my healthcare providers and healthcare insurers that have provided treatment, payment or services to me or for me to disclose any information regarding

By submitting this application to Laurier, I agree that Wilfrid Laurier University and the LEAF Pre-MBA Program may exchange my application and academic information for

I authorize the educational institution to release information related to my enrollment to the selection committee for MobileDemand’s Innovative Minds Scholarship. Is the

I agree that Sterling Credit Group is authorized to release my information from time to time regarding the status of my total number of public records, total number of

I authorize AMCB to communicate information concerning my application and certification status to public authorities, employers and others. I hereby represent that this application

 The health history information given is correct to the best of my knowledge.  I agree to notify Health Records Office regarding any significant change in health status. 

I hereby authorize and permit Sequel Youth Services to hereafter investigate and disclose information contained in this application and such additional information regarding

I have read and understand the enclosed information regarding the Military Order of the Purple Heart Scholarship Program. During the 2013-2014 academic year, I plan to attend