Have an account? Click here to log in...

2024 Mary C. Manning Scholarship Application

First Name

Last Name

Student ID Number

Home Address

City

State

Zip

Phone

Phone Type

Cell
Home
Work

College Attending

Major being pursued

Year in school

Please briefly describe your career goals:

Please highlight any school or community service activities you have recently participated in:

Are you familiar with Breathe New Hampshire or do you have a connection to the organization?

How do you see the importance of lung health as it applies to your future career goals?

How did you hear about the Mary C. Manning Scholarship?

Do you currently vape or use tobacco products?

Yes
No

Electronic Signature:

By typing your name below you certify that the information in this application is true and complete to the best of your knowledge

Signature of Parent or Guardian (if under 18 years of age)

Relationship to Minor

Today's Date

// (mm/dd/yyyy)

Thank you for your application to the Mary C. Manning Scholarship. Please email info@breathenh.org with your college letter of acceptance or college transcript as well as one letter of reference by September 15th. We will be reviewing applications in September and notifications will be made by the end of November. Thank you.

Or sign in with

Forgot your password?

Enter the e-mail address associated with your account and we'll send you a link to recover your login information.

Email

Close this window to continue as a new account.

Neon CRM by Neon One

Timeout Warning

2024 Mary C. Manning Scholarship Application