MWF Scholarship Application Form

Scholarship Application Form

Application Deadline - March 31st
I. Personal Data:

Tell us about yourself
Full Name*

First NameLast Name
Birthdate:*

MonthDayYear
Phone No. :*
E-mail :*
Where the confirmation will be send to
Home Address :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's Address :

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Address :

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
With Whom Do You Live:*
List Siblings Ages at Home and their ages:
Family Annual Income:

$0-$25,000$25,00-$50,000$50,00-$75,000$75,00-$100,000Over $100,000
Please provide any information you would like the committee to consider regarding your financial need:

II. High School Academic Profile:

Test Scores

	SAT Reading	SAT Math	SAT Writing	SAT Total	ACT Composite

School Info

	Number In Class	Rank in your Class	GPA

I understand that if I am selected to receive a scholarship, my final approval is contingent upon the completion of my high school requirements prior to August 31 of my graduating year. If I do not meet this requirement, I relinquish any right to the Michael Wilkinson Foundation Scholarship. I also understand that I must be enrolled in college no later than the fall semester following my high school graduation or I may forfeit the scholarship.
Signature

Clear
Guardian Signature

Clear
From which ISD High School will you be graduating?

What are your top three choices for college/vocational schools?


First Choice
Second Choice
Third Choice

What are you planning to select as your major course of study?
What are your educational and professional goals and objectives?
III. Employment Information:
Do you plan to be employed during college?

YesNo
Why or why not?

Please list your employment record for the last FOUR years and note if you have worked during the school year or summer break:

	Place	Position	Date (MM/YY)	Hours Per Week

IV. High School, Community, Church Organizations and Activities:

Please list all organizations and activities (including community service) in which you have been involved for the past four years. Include grade, organization/activity, honor/award and office held.

	Grade	Organization/Activity	Honor/Award	Office held

V. Hobbies / Extracurricular:
Please list your hobbies, outside interests, extracurricular activities, and anything else that you think might influence our decision

0/500
VI. Essay Question and Recommendation Letters:
Essay Question Upload: Subject - Schools in the United States today have a growing substance abuse and addiction crisis. Based on your personal knowledge or experiences, how can you affect change with your generation in battling this epidemic?

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One Letter of Recommendation from a teacher, counselor or school administrator

Cancelof
One Letter of Recommendation from an employer, minister, neighbor or adult friend over 21 years of age

Cancelof
(School Name) is committed to equal opportunity in employment and education. The College does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
Should be Empty:

Scholarship Application Form

I. Personal Data:

II. High School Academic Profile:

III. Employment Information:

IV. High School, Community, Church Organizations and Activities:

V. Hobbies / Extracurricular:

VI. Essay Question and Recommendation Letters: