High School Scholarship Application Form

NEW YORK CHAPTER CHUMS, INC.

HIGH SCHOOL GRADUATING SENIOR SCHOLARSHIP APPLICATION.
DEADLINE TO APPLY IS 4/11/2026
STUDENT INFORMATION
Student's Full / Legal Name*

First NameLast Name
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Phone Number*

Area CodePhone Number
Student E-mail*
Student Birth Date*

MonthDayYear
Guidance Counselor Phone*
Pronouns

Academics
High School Name*
High School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Guidance Counselor Name*
Guidance Counselor Email*
Academic GPA*
Schools to which you are applying

Please enter the names of the schools to which you are applying.
School 1*
Your primary choice.
School 2
Your second choice.
Major(s) You Are Considering

In order of preference, list the major(s) you are considering (Very important for scholarship eligibility).
Major 1*
Major 2
Minor
College Estimated Cost

Please select the estimated cost using the drop down below,
School Estimated Cost*

SCHOOL / COMMUNITY ACTIVITIES / WORK / EXPERIENCE/SPORTS/AWARDS/ETC:

List name(s) of club, etc. and years of participation. If you volunteered, list the name of organization(s) and the number of hours, weeks and years that you volunteered. If you worked, list the company, hours per week and length of time. Attach an additional sheet or resume if necessary.
School Activities / Clubs 1: (not sports)
School Activities / Clubs 2: (not sports)
School Activities / Clubs 3: (not sports)
Community Service / Volunteer Activities 1
Please include how many hours you served completing this activity.
Community Service / Volunteer Activities 2
Please include how many hours you served completing this activity.
Community Service / Volunteer Activities 3
Please include how many hours you served completing this activity.
Sports Participation 1
Sports Participation 2
Sports Participation 3
Will you be participating in a sport(s) during college?

YesNo
What Sport?
School / Community Awards and Honors 1
Ex: National Honor Society
School / Community Awards and Honors 2
School / Community Awards and Honors 3
EMPLOYMENT 1: List past and present work and length of time employed.
EMPLOYMENT 2: List past and present work and length of time employed.
EMPLOYMENT 3: List past and present work and length of time employed.
Resume Upload

Browse Files
If you would like to upload a copy of your resume, please upload it here. Cancelof

Please describe your future goals and where you plan to be in five (5) years. *
Essay Prompt: In what ways has your participation in community service influenced who you are today, and how will these experiences guide your five-year plan to make a meaningful impact and pay it forward?*
Essay Upload

Browse Files
If more space is required or you would like to upload a copy of your essay, please upload it here. Cancelof
Official Transcript*

Browse Files
Please upload an official transcript sealed by your guidance counselor. Cancelof
Student Signature*
Parent/Guardian Name*
Please type the Parent/Guardian Name.
Parent/Guardian Signature*
Submission Time

MonthDayYearHourMinutesAM/PM Option
Should be Empty:

NEW YORK CHAPTER CHUMS, INC.