Deadline is March 1st
Scholarship applications are accepted for graduating high school students residing in and attending high school in JacksonCounty. Applications are accepted only from students who also complete the application process for the Houston Livestock Show & Rodeo Scholarship. Awards are made based on academic achievement, merit, and financial need. Please type or print legibly in blue or black ink. Questions regarding scholarship applications should be directed toward your local Go Texan representatives: Kurt Stancik – 361.771.8000, Kenneth Land – 361.781.2138, or Dennis Ray – 361.782.1194.
Personal Information
Social Security Number: _____ - ____ - ______Date of Birth:_____ / ______/ ______
Full Name: ______Preferred Name: ______
Home Physical Address: ______
City: ______State: ______Zip Code: ______
Home Mailing Address (if different): ______
City: ______State: ______Zip Code: ______
Primary Phone: (______) ______-______Alternate Phone: (_____) ______-______
E-mail Address: ______
Preferred Method of Contact: Phone E-mail Postal Mail
Optional Biographical Information:
Ethnic Race: White Black Hispanic Asian or Pacific Islander American Indian Other
Gender: Male Female
International Student: Yes No
Family Information:
Father’s Name: ______ Living Deceased
Home Address: ______
Occupation: ______Employer: ______
Highest Level of Education: High School/GED Some College Bachelor’s Master’s or Higher
Mother’s Name: ______ Living Deceased
Home Address: ______
Occupation: ______Employer: ______
Highest Level of Education: High School/GED Some College Bachelor’s Master’s or Higher
Do you have other siblings living at home: Yes - Ages ______ No
Do you have other siblings attending college: Yes – where? ______ No
ducational Information ______
Educational Information
Academic Achievement:School Name: __ City: ______Graduation Date: ______
Class Rank: ______Number in Graduating Class: ______Date of Ranking: ______
HS GPA: ______on ______scale SAT Score:______ACT Composite: ______
HS Official Signature: ______Date: ______
By signing, the HS Official verifies that the academic information presented on this application is accurate.
HS Official Name: ______Position: ______
Phone: ______Email: ______
List any academic honors, awards, or membership activities while in high school: ______
______
______
Educational Goals:
Anticipated College Enrollment: Full-time Part-time Month/Year: ______/______
Name of College or University you expect to attend: ______
Have you applied: Yes No Have you been accepted: Yes No
Housing Plans: On campus Off campus At home with parent(s)
Tuition cost: $______per Credit hour Semester Year
Anticipated Field of Study: (1) ______(2) ______
Extra-Curricular Information
Identify any volunteer, civic, and/or extra-curricular activities you participated in while in high school.
Applicant may include an additional document if more space is required.
Activity / Dates: From-To / Hours/Week / Total Hours / Responsibility / Accomplishments
Application Requirements
Enclose the following documents with your scholarship application:
Completed Application
Current Photograph of Applicant
Submit your application to:
JacksonCounty Go Texan Scholarship, PO Box 743, Edna, TX77957
Application deadline:
March 1st
For Office Use Only
Application Date: ______Verified w/ HS: ______Rep: ______
Revised – Jan 2013