2021 Ben B. Cheney Foundation Scholarship Application

2021 High School Scholarship Program Application
Complete applications due by March 15, 2021.

Find scholarship eligibility and information at benbcheneyfoundation.org/scholarship. Only complete and eligible applications will be reviewed.
First Name: *
Middle Initial: *
Last Name *
Email *
Please re-enter email to confirm
Mailing Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *

Area Code Phone Number
High School Athletic Team *
Do you attend school at SAMi, SOTA, or iDEA? Please indicate below.
Cumulitive GPA *
How Did You Hear About This Scholarship? *
If Other, Please List
Gender
Name of Father or Guardian
Name of Mother or Guardian
WIAA JV or Varsity Sport(s) Played (check all that apply) *

Baseball Basketball Bowling Cross Country Football Golf Gymnastics Soccer Softball Swim & Dive Tennis Track & Field Volleyball Wrestling
To be eligible for this scholarship, you must have participated on a junior varsity or varsity high school athletic team that engaged in interscholastic competition. Please list the calendar year(s) played (ie 2019, 2020), the level (JV, varsity), and head coach(es) name for the each of the sports you marked above.
Please list any volunteer/community service, extracurricular activities and/or offices you held in high school. Indicate the calendar year(s) for each one.
Please list the vocational & technical school, 2-year or 4-year college(s) you have applied to. Write "accepted" after any school that has already accepted your application.
First Personal Reference Name:

First Name Last Name
First Personal Reference Phone Number:

Area Code Phone Number
First Personal Reference Email:
example@example.com
Relationship to First Personal Reference
Second Personal Reference Name:

First Name Last Name
Second Personal Reference Phone Number:

Area Code Phone Number
Second Personal Reference Email:
example@example.com
Relationship to Second Personal Reference:
Participation in athletics significantly influenced the life of our founder, Ben B. Cheney. How has participation in athletics influenced your life? What life lessons have you learned through athletics?(300 words max) *

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2021 High School Scholarship Program Application

Complete applications due by March 15, 2021.