Scholarship Application Form

Scholarship Applications Introduction and Requirements



Full Name

Full Street Address


Your Email (required)

Date of Birth



Father's (or Guardian) Name

Father's Occupation

Father's Employer

Father's MHHA Number

Father's ORC Licence Number

Mother's (or Guardian) Name

Mother's Occupation

Mother's Employer

Mother's MHHA Number

Mother's ORC Licence Number


Educational institution you will be attending for the upcoming academic year:

School Name

School Full Street Address

School Phone

Degree Pursued

Area of Study

List the schools you have attended, including high school with the most recent school first and provide dates of your attendance. If college, please indicate if you obtained a degree.

Together with this application, you must submit a certified academic transcript of your entire high school career and/or your entire record in a post-high school institution. If your official transcript is not available by April 15, 2017 send all other documentation and note that your transcript will be forthcoming with a projected date of arrival.


List any honors you have received and any noteworthy participation in special programs, school or community activities, or athletics with dates of participation.

Please provide information about the Activity/Program/Award, The sponsor, and the dates for each activity.

List any jobs you have held in the past few years

Please provide dates employed, position, employer, and hours per week for each job.

Please briefly describe your present and future professional and career goals.


Cost of your tuition, room and board, and books for the upcoming academic year.

Estimation of funds available to you for the upcoming year

From Family

Personal Earnings



Other Scholarships

How are you, personally, contributing to the cost of your education?

Please attach two letters of recommendation from:
School Official (teacher, coach, administrator) and
Other (employer, community member, non-family member)

Please attach a brief essay explaining how you are involved in the harness racing industry, and how it may have determined your future. Indicate why you are seeking and believe you deserve financial assistance from the MHHA. For purposes of anonymity, do not include personal names.

Together with this application you must submit a certified transcript of your entire high school career and/or your entire record in a post-high school institution.

By signing this application, I certify that all of the information provided herein is complete and accurate to the best of my knowledge. I agree to provide the scholarship committee with any further information or documentation it may request. Please check this box if you agree