Worcester Public Schools Online Scholarship Application Form
The Worcester Women’s Leadership Conference (WWLC) Committee would like to offer 10 seniors from the Worcester Public Schools, admittance to the 2025 Worcester Women’s Leadership Conference on June 12. APPLICATION DEADLINE: MAY 1
Email
example@example.com
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Are you a citizen of the United States? This does not affect your eligibility.
Yes
No
Please indicate your Ethnicity:
Has any immediate family member attended college?
Yes
No
If a family member has attended college, who and where?
What is your estimated family household income?
Have you participated in any mentorship program(s) in the past? If yes, where?
Have you participated in any community service? If so, please describe:
Are you planning on staying in the Central MA area after high school graduation?
Yes
No
Unsure
EDUCATION
High School Name:
Date of Anticipated Graduation:
What are your goals for after High School? Please list your anticipated focus of study in College, major(s), type of work or specific higher education program.
REFERENCES
Please list three personal references
Reference 1: Full Name, Company, Relationship, Email and Phone Number
Reference 2: Full Name, Company, Relationship, Email and Phone Number
Reference 3: Full Name, Company, Relationship, Email and Phone Number
May we contact your references?
Yes
No
VIDEO INSTRUCTIONS
To complete this application you must submit a three-minute video to Stefanie Silva at ssilva@worcesterchamber.org. Video and application will be shared with the Worcester Women’s Leadership Conference Scholarship Selection Committee for review. Video must be a three minute video maximum on: What leadership means to you? and / or- What you hope to gain from attending this conference?
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge. If this application leads to acceptance, Worcester Women’s Leadership Conference has the right to use your video for public display. I understand that false or misleading information in my application may result in my disqualification of this application.
Signature
Submit
Should be Empty: