Scholarship Form

Submit your application materials by December 21st, 2018 11:59 p.m. PST to be considered for the 2019 Spring scholarship!

Student Information

  First Name *
  Last Name *
  Email Address *
  Phone Number *

Education Information

  University Name *
  City/State/Country *
  Expected graduation date (month/year) *

Application Materials

  Transcript Upload *   
  File size: Less than 2MB.
  Acceptable file formats: pdf, doc, docx
Write a personal statement of 500 words or less on what scientific discovery has impacted your life. *
I certify that this application and all of the supporting documents are accurate and complete. I understand that if selected for an award, I may be required to provide proof of the information stated on this form. If selected to receive an award, I agree that my name, my photograph, and the award amount can be used in announcements and articles (e.g., social media, newsletters) issued by GeneTex, Inc.
  Electronic Signature
(please type name)
 I understand and accept GeneTex Privacy Policy