The St. Pierre Alliance Scholarship Application

The St. Pierre Alliance Scholarship Application
Name*

First NameLast Name
Email*
example@example.com
Name of the institution of higher education you are currently attending or planning to attend.*
Phone Number*

Area CodePhone Number
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about our scholarship?*
Education Information
Name of High School Attended*
High School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your high school cumulative GPA?*
Year Graduated*
Date Expected to Graduate*

MonthDayYear
Date
Academic awards and/or honors you received in High School
Are you a member of any organization in your high school? Please provide information
If you have a GED Certificate for High School Equivalency, please provide the information below:
Date received GED Certification

MonthDayYear
Date
Are you a member of any organization outside your school? Please provide information
Are you a First Generation College Student?*
What is your declared Major?*
Total academic credit hours completed?*
Are you a full-time student?*
What is your college cumulative GPA?*
If you are a transferree from another college or university, please fill out the fields below:
Name of College Last Attended
Academic Year Last Attended
Please provide any academic achievements or awards you have received in College (if there is any)
Performance Coaching Scholarship Option

Students who opt into the Performance Coaching Scholarship Program receive one year access to credentialed performance coaches at no cost--Overcome challenges, discover solutions, achieve goals, and celebrate victories. Schedule coaching sessions as you desire. Performance coaching is not required for the St. Pierre Alliance Scholarship but is encouraged for your benefit.
If awarded a The St. Pierre Alliance Scholarship, would you like to opt into the Performance Coaching Scholarship Program? *

Parental Information
Name of Mother or Guardian*

First NameLast Name
Mother's Job/Position*
Address of Mother*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Father*

First NameLast Name
Father's Job/Position*
Address of Father (if not the same as above)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Financial Information
Are you a dependent of your Parents?*

YesNo
Your Family's Joint Annual Income*
Are you working? If yes, please provide details below*

Upload your essay telling us about your success in spite of hardship and how your education path will create a better future for you. *

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I CERTIFY THAT ALL STATEMENTS OR INFORMATION I HAVE PROVIDED ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ANY DELIBERATE MISREPRESENTATION FOUND IN THIS APPLICATION MAY BE CAUSE FOR DISAPPROVAL OF THIS APPLICATION AND MAY PROHIBIT ME FROM APPLYING AGAIN IN THE FUTURE.
Name of Applicant*

First NameLast Name
Date Signed by Applicant*

MonthDayYear
Date
Should be Empty:

The St. Pierre Alliance Scholarship Application

Education Information

Performance Coaching Scholarship Option

Parental Information

Financial Information