Scholarship Application – New Applicant

Student's name *

First

Last

Date of birth *

Home address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Cell number *

Current school *

Expected date of graduation *

Grade point average weighted *

Grade point average unweighted *

School you plan to attend *

FAMILY INFORMATION

Name of parent *

First

Last

Occupation *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell phone *

Email *

Name of parent *

First

Last

Occupation *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell phone *

Email *

Family's annual gross income *

Other income Yes/No *

If yes, please explain

Number of brothers/sisters living at home and ages *

Number of brothers/sisters currently attending college *

Number of other relatives living at home and ages *

Other information

Please note any other information that would be helpful to the College Scholarship Committee.

FINANCIAL ASSISTANCE INFORMATION

Loans *

Source of loan, amount applied for, amount received

Scholarship(s) *

Source of scholarship(s), amount applied for, amount received

Grants *

Source of grant, amount applied for, amount received

Family assistance *

Source of assistance, amount received

Other *

Describe any other financial support you/your family is receiving

Estimated annual education expenses - Please provide a copy of your FASFA *

Tuition, books, room & board, transportation, other

APPLICANT'S ESSAY

Please respond to the following questions in your own words *

What are your goals? That is, what do you want to accomplish with your life? What will others do to help you reach these goals? What will you do to make this happen?

STUDENT'S ACTIVITIES

Extracurricular *

Enter grades (9, 10, 11, 12) and leadership position(s)/accomplishment(s)

Community involvement (non-school related) *

Enter community groups (place of worship, club, committee, etc.), grades (9, 10, 11, 12), and lever of involvement

Special recognition/awards *

Enter commendation(s), grades (9, 10, 11, 12) and activity(ies)

Please describe any other talents, interests, or activities not included above *

APPLICANT'S REFERENCE(S)

Please paste the reference(s) you have received - Reference must state name, title, and date *

How many years have you known the applicant? In what capacity did you work with the applicant? Include information concerning the applicant's personality, initiative, maturity, motivation, and other traits which may be relevant to this application.

FAMILY INFORMATION

FINANCIAL ASSISTANCE INFORMATION

APPLICANT'S ESSAY

STUDENT'S ACTIVITIES

APPLICANT'S REFERENCE(S)

PLEASE MAKE SURE TO REVIEW YOUR APPLICATION AND FILLED OUT ALL REQUIRED FIELDS BEFORE APPLYING. THANK YOU.