Application to Join
Student Name
*
First Name
Last Name
Age
*
ex: 23
Grade
*
High School
*
Current GPA
*
ex: 2.5
Student Phone
*
-
Area Code
Phone Number
Student Email
*
example@example.com
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone
*
-
Area Code
Phone Number
Parent/Guardian Email
*
example@example.com
Upload Your 300 Word Essay, Letter of Reference, and Photo.
*
Browse Files
Drag and drop files here
Choose a file
ESSAY Topics: What do you plan to contribute to the world? or Why do you want to be a part of this program?
Cancel
of
If I am selected for the program, I agree to the following:
*
Rows
Check to Acknowledgement
I will participate in monthly scheduled meetings.
I will complete assignments as requested.
I will meet with the Scholarship Lady monthly.
I will meet with an assigned mentor bi-monthly.
I will apply to and attend college.
I will succeed and be a productive member of society.
I will abide by the Program Code of Conduct.
Submit
Should be Empty: