Chicago Blackhawk Alumni Association Scholarship Program
Name
*
First Name
Last Name
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
*
Please enter a valid phone number.
Mother's Name, Occupation
*
Father's Name, Occupation
*
Number of Siblings (please include names and ages)
*
Annual Household Income
*
Please Select
Below $50,000
$50,000 - $100,000
$100,000 - $150,000
$150,000 - $200,000
Above $200,00
High School
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School Contact (Student Advisor)
*
Phone Number
*
Please enter a valid phone number.
High School GPA
*
Class Rank (if applicable)
SAT Score (if applicable)
ACT Score (if applicable)
Hockey Coach Name
*
Phone Number
*
Please enter a valid phone number.
Position
*
Teams Played On (previous 4 years)
*
Will you apply for financial aid to assist with your college expenses?
*
Is some sort of financial aid necessary for you and your family to afford tuition at the college of your choice?
*
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Please list, and describe, any community service that you do/have done.
*
Please list, and describe, any extracurricular activities you are involved with (in/out of school, excluding hockey).
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Please list any past or current paying jobs.
*
Name of University #1
*
Does this university have a hockey program?
*
Name of University #2
*
Does this university have a hockey program?
*
Name of University #3
*
Does this university have a hockey program?
*
Please list any other universities that you have applied.
*
Signature
*
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How has your experience playing hockey and your exposure to the sport of hockey assisted you in your development as a student and as a person? (400 word maximum).
*
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What other qualifications do you have that you believe make you eligible to be rewarded with the Blackhawk Alumni Scholarship? (400 words max.)
*
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Coach's Letter of Recommendation
*
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Attach a letter stating if your coach will be sending his/her recommendation directly. Recommendations should be sent to: Chicago Blackhawk Alumni Association - PO Box 72159 - Roselle, IL 60172
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Letter of Recommendation #1: Teacher or Mentor
*
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Attach a letter stating if your teacher or mentor will be sending his/her recommendation directly. Recommendations should be sent to: Chicago Blackhawk Alumni Association - PO Box 72159 - Roselle, IL 60172
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Letter of Recommendation #2: Additional Teacher or Mentor
*
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Attach a letter stating if your additional teacher or mentor will be sending his/her recommendation directly. Recommendations should be sent to: Chicago Blackhawk Alumni Association - PO Box 72159 - Roselle, IL 60172
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Unofficial Transcript
*
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Attach a letter stating if your unofficial transcript will be sent directly to the Chicago Blackhawk Alumni Association - PO Box 72159 - Roselle, IL 60172
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Submit
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