Personal Information

Name *

Date * +

Address (Street, City, State, Zip) *

Birthday *

Social Security Number *

Phone Number *

Email Address *

High School *

Grade Level *

GPA *

Parent/Guardian *

Phone Number *

Parent's Email Address *

How many Brothers: *

How many Sisters: *

Scholastic Information

Expected date of High School Graduation * +

List clubs or other extra-curricular activities, positions/office held and length of time served in position/office *

List any awards or honors you have received *

Provide a copy of your last transcript (Please attach copy of Transcript only) *

What Subjects are you considering as majors in college? (List in order of course emphasis) *

+-

College/University selected to attend (List in order of preference) *

+-

Have you been accepted? *

Yes

No

If Yes, school name: *

Have you received or are you expecting to receive any scholarships (academic, music or sports) for college? *

Yes

No

Type of Scholarship *

Amount *

If you have received or expect to receive a scholarship (academic, music, sports), will it provide?

Yes

No

Full Scholarship (1 to 4 years) Time Period - *Indicate Time Period, i.e., 1 year, 2 years, etc.

Essay Question

GENERAL DIRECTIONS: Must be typed, double spaced, and with at least the required minimum words. Please ensure grammar and spelling is correct. You may use additional pages. Please type your identification at the top of each page.

What are your career goals and why should you be selected for this scholarship? How will earning a college degree help you achieve those goals? (500 Minimum Words. Typed. Double-Spaced) *