PUSDEF SCHOLARSHIP APPLICATION

PUSD EDUCATION FOUNDATION GENERAL SCHOLARSHIP APPLICATION
1.Personal Information
Name*

First NameLast Name
Other Names (if applicable)
Mailing Address*
City*
State *
Zip Code*
Email*
example@example.com
Home Phone Number*
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.

2. Educational Background – High School
High School You Attended (1)
From
Year
To
Year
High School You Attended (2)
From
Year
To
Year
3. Household Income
Your Household Income?

Under $40,000$41,000 to $70,000$71,000 to $90,000$91,000 to $120,000$121,000 and above

4. Extracurricular Activities in High School

(Choose up to five and list from highest significance to lowest significance)
High School Activity 1
From
Year
To
Year
Your role
Estimated Hours Involved
High School Activity 2
From
Year
To
Year
Your role
Estimated Hours Involved
High School Activity 3
From
Year
To
Year
Your role
Estimated Hours Involved
High School Activity 4
From
Year
To
Year
Your role
Estimated Hours Involved
High School Activity 5
From
Year
To
Year
Your role
Estimated Hours Involved

5. Employment - While Attending School

(choose the three most recent)
EMPLOYMENT 1: List title, duties and length of time employed
EMPLOYMENT 2: List title, duties and length of time employed
EMPLOYMENT 3: List title, duties and length of time employed

6. Public Service and Community Activities while in High School

(choose up to five and list from highest significance to lowest significance)
Community Activity 1
From
Year
To
Year
Your Role
Estimated Hours Involved
Community Activity 2
From
Year
To
Year
Your Role
Estimated Hours Involved
Community Activity 3
From
Year
To
Year
Your Role
Estimated Hours Involved
Community Activity 4
From
Year
To
Year
Your Role
Estimated Hours Involved
Community Activity 5
From
Year
To
Year
Your Role
Estimated Hours Involved

7. Awards and Special Recognitions in High School

(choose up to three and list from highest significance to lowest significance)
1-Award
Date Received
Year
What Did You Do To Receive The Award?
2-Award
Date Received
Year
What Did You Do To Receive The Award?
3-Award
Date Received
Year
What Did You Do To Receive The Award?

8. Future Education Plans

(up to three)
What are your college or technical school choices? (1)
What are You Planning to Study?
Have You Been Accepted?

yesno
Your Classes Start
Year
What are your college or technical school choices? (2)
What are You Planning to Study?
Have You Been Accepted?

yesno
Your Classes Start
Year
What are your college or technical school choices? (3)
What are You Planning to Study?
Have You Been Accepted?

yesno
Your Classes Start
Year

9. Are you the first in your family to attend college?
Please tell us,are you the first in your family to attend college?

yesno
10.Financial Need
Why do you need financial assistance and what are you doing, other than applying for this scholarship, to meet the need?
11. Essay Questions
11a. What challenges have you had to overcome (e.g., financial, personal, medical)?
11b. What are your academic and career goals and your plans to achieve them?
11c. What additional information do you want the scholarship committee to know about you?

12. Statement of Assurance and Understanding
- I hereby assure that all the above stated information provided by me is true and correct to the best of my knowledge.
- I consent that if chosen as a scholarship recipient my picture may be taken and used to promote the PUSD Education Foundation’s scholarship program.
- I hereby understand that if chosen as a scholarship recipient I must be present at the PUSD Scholarship Awards Night to receive my scholarship award and provide the donor with either a thank-you note or a 'selfie-video' thank-you.
- I hereby understand that if chosen as a scholarship recipient, it is my responsibility to remit to the PUSD Education Foundation the appropriate information for my scholarship to be paid directly to my educational institution.
- I hereby understand I will not submit this application without all required attachments and supporting information. Incomplete applications or applications that do not meet eligibility criteria will not be considered for this scholarship.
Signature of Applicant

Clear
Date

MonthDayYear
Date
Upload Documents Here (two letters of recommendation and transcript)

Cancelof
Before submitting, please to make sure that you have completed the application form, uploaded the required documents and signed the Statement of Understanding.

Once you click on the submit button, you WILL NOT be able to go back and add, change or upload documents to your application
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