References: Two Letters of Recommendation Addressed to the Scholarship Committee from Teachers

Applicant Information:
Name: Last / First / MI
Address
City / County / State/Zip
Telephone
Transcript/Report Card Information:
Students must include a high school transcript.
SAT Score / ACT Score
Applicant Rank / in a class of
Cumulative GPA* (weighted)
Financial Information:
The Selection Committee can evaluate your financial need only if it knows how you are supported.
Father’s Name
Occupation
Years of school completed
Mother’s Name
Occupation
Years of school completed
Number of children in family / Number of children in college
Total of Scholarships awarded / $ / Grants Awarded: Pell, State, etc. / $
List all financial assistance applied for but not yet awarded:
College Selection:
Names of colleges to which you will be applying in the Fall and circle if you have already been accepted or not. If accepted, please submit a copy of your acceptance letter.
1. / Accepted: Yes No
2. / Accepted: Yes No
3. / Accepted: Yes No
Planned Major(s) or field of study:

References: Two letters of recommendation addressed to the Scholarship Committee from teachers, counselors or administrators are required.

Essay:

Please submit an essay (limited to two pages) of your goals and how this scholarship could assist in achieving your goals.

Activities, Honors & Awards, Work Experience:
List all activities, honors, and/or organizations in which you have participated while in high school. In addition, list all job experiences and/or volunteer activities. If additional room is needed, please list on a separate sheet of paper.
Sports / Activities / Years Participated
Honors / Years Participated
Organizations / Years Participated
Summer Jobs / Years Participated
Certification:
I certify that all of the information on this form is accurate and complete to the best of my knowledge. The application package becomes the property of the scholarship committee and will not be returned or acknowledged. Falsification of information may result in termination of any scholarship granted.
Applicant’s Signature: / Date:
Application Checklist:
Applicants are required to send the total application package together in the following order. It is the applicant’s responsibility to see that this application is complete and all materials are sent together. Incomplete applications will not be processed.
1. / Application-must be complete and signed and include the college or trade school acceptance letter. / 3. / 2 Reference Letters
2. / Transcript / 4. / Essay
Application Deadline: By 3:00 p.m. Thursday, March 31, 2016