ECR Scholarship Contest Form
Submit this application to enter the ECR Scholarship contest. In addition to submitting this form, please send your essay to:
Full Name *

Mailing Address *

Contact Number *

Name of Your School *

Short bio about yourself

Your bio may be posted on
How has smoking affected your life?

In the past, what have you done to raise awareness about smoking cessation?

What message would you give to smokers who are struggling to quit?

Do you accept and meet the eligibility requirements to submit your scholarship application? *

(1) You are 14 years old or older; (2) You are accepted to or enrolled in a high school, college or university in the United States; and (3) You have read and understand the ECR Scholarship Rules.
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