Calvin Jones Sr. Memorial Scholarship Program

Calvin Jones Sr. Memorial Scholarship Program
St. John Missionary Baptist Church
662 South 52nd Street - Richmond, CA 94804
Dr. Kevin B. Hall, Pastor
All Information Will Be Kept Strictly Confidential
PERSONAL INFORMATION
Name

First Name Middle initial Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Email
example@example.com
Date of Birth

Month Day Year
Date
Gender

Male Female
Name of High School Currently Attending
High School City
Name of College, University, or Program you plan to attend in the Fall
Proposed Major or Field of Study
ACTIVITIES

Church Participation

	Activity	Description	From	To

School Activities

	Activity	Description	From	To

School Activities

	Activity	Description	From	To

Volunteer Work and Community Service

	Activity	Description	From	To

Work Experience

	Activity	Description	From	To

Honors and Awards:
I certify that the information contained within this application is accurate and that I am the author of the attached essay.
Signature

Clear
Should be Empty:

PERSONAL INFORMATION