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Change Your Life Scholarship Contest Entry Form

The Change SOMEONE'S Life DELL Contest rules are simple. For each person you invite to win a full scholarship, or invite
to take the brain dominance test, we will enter you to win the Change SOMEONE'S Life DELL Contest.

If you decide to do both we will enter you twice. You are invited to enter as many times as you like and invite as many
people as you wish.

[An asterisk (*) indicates a required field]

Section A: Please select the school scholarship you wish to invite the person/s to win - or invite them to take the brain dominance test, or both.


If you yourself are interested in more information on a particular program at this school, please select a location and program below and check the box.



Check box if you would also like more info on this particular program in the form of a program info kit

Section B: Enter yourself to win a Dell Inspiron 14R Laptop AND accompanying Dell C1760nw Color printer by making your selection below. *  

Section C: Please tell us about yourself below
Your information

Email Address: *
First name: *
Last name: *
Day phone: * - -  
Address: *
Address 2:
City: *
Province/State: *  
Zip/Postal Code: *
Country: *  

Section D: The person/s I wish to nominate to win the full scholarship, invite to take the brain dominance test or do both are:

First name:
Last name:
Email Address:
First name:
Last name:
Email Address:
First name:
Last name:
Email Address:

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