Scholarship Application Form
Name
First Name
Last Name
Birthdate
MONTH, DAY
YEAR
CONTACT INFORMATION
VOLUNTEER MOBILE
HOME
EMERGENCY CONTACT
NAME
NUMBER
In 250-500 words, please answer the following questions: 1. why do you want to be apart of the program? 2. do you see yourself as a leader and why? 3. why do you feel you deserve this scholarship?
Mother Mobile
Father Mobile
Guardian Mobile
Message Number
Father Work
Mother Work
Guardian Work
Other
Student email
example@example.com
Mother email
example@example.com
Father email
example@example.com
Guardian Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please upload a video of you telling us a little about your self. This video should include: 1. Your full name 2. Hobby(ies) 3. What school you attend 4. Your grade 5. Best and favorite subject in school and why 6. What extra curriculum activities you are involved in and why 7. What you would like to be and/or do once you have graduated high school and college? why.
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Do you have a GPA of 2.5 or higher
Please Select
Yes
NO
Have one or more of your parents attended and/or graduated from college?
Please Select
Yes
NO
Currently attending college
Some college, but didn't graduate
Have any one other than your parents attended and/or graduated from college?
Please Select
Yes
NO
House hold details (ie any additional house hold member ages, names, and birthday.
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