Scholarship Application

NAME*
ADDRESS*
ZIP
Phone*
Email*
AGE
DATE OF BIRTH
MM slash DD slash YYYY
SS#
US CITIZEN
Middle School Attended
Elementary School
RANK IN CLASS
Numeric Avg.
ACT Composite
SAT Combined
Parent/Guardian Name/Occupations/Places of Employment
Number of brothers/sisters
Ages
How many family members, including yourself, will be in college next year?
List most notable community activities & school-related extra-curricular activities during grades 9 – 12 and check the appropriate grade level(s)
ACTIVITIES
Grade level
Level of Involvement (i.e. officer, member, etc.)
ACTIVITIES
Grade level
Level of Involvement (i.e. officer, member, etc.)
ACTIVITIES
Grade level
Level of Involvement (i.e. officer, member, etc.)
ACTIVITIES
Grade level
Level of Involvement (i.e. officer, member, etc.)
List special recognition, awards and honors received during grades 9 – 12 and check the appropriate grade level(s).
SPECIAL RECOGNITION, AWARDS OR HONORS
Grade level
Group or Activity Sponsoring the recognition
SPECIAL RECOGNITION, AWARDS OR HONORS
Grade level
Group or Activity Sponsoring the recognition
SPECIAL RECOGNITION, AWARDS OR HONORS
Grade level
Group or Activity Sponsoring the recognition
SPECIAL RECOGNITION, AWARDS OR HONORS
Grade level
Group or Activity Sponsoring the recognition
List and describe any work experience during grades 9 – 12 and check the appropriate grade level(s).
PLACE OF EMPLOYMENT
Grade level
Job Description
Supervisor
PLACE OF EMPLOYMENT
Grade level
Job Description
Supervisor
PLACE OF EMPLOYMENT
Grade level
Job Description
Supervisor
PLACE OF EMPLOYMENT
Grade level
Job Description
Supervisor
What college do you plan to attend?
Estimate college expenses for freshman year
Student Photo
Max. file size: 64 MB.
Print Name
Student Transcript
Max. file size: 64 MB.
Graduating Year
Student’s Signature
Max. file size: 64 MB.
Date
MM slash DD slash YYYY
Essay #1
Accepted file types: doc, docx, pdf, txt, Max. file size: 64 MB.
Essay #2
Accepted file types: doc, docx, pdf, txt, Max. file size: 64 MB.
Parent’s Signature
Max. file size: 64 MB.
Date
MM slash DD slash YYYY
Print Name

Scholarship Application

List most notable community activities & school-related extra-curricular activities during grades 9 – 12 and check the appropriate grade level(s)

List special recognition, awards and honors received during grades 9 – 12 and check the appropriate grade level(s).

List and describe any work experience during grades 9 – 12 and check the appropriate grade level(s).