2023 Ben B. Cheney Foundation Scholarship Application

2023 High School Scholarship Program Application
Complete applications due by March 15, 2023.

Find scholarship eligibility and information online at benbcheneyfoundation.org/scholarship. Only complete and eligible applications received by the deadline will be reviewed. Make sure that your email address, mailing address, and phone number are correct and will still work after graduation.(school emails sometimes disable after graduation) This is the information we use to contact scholarship winners and arrange scholarship payments to the college or school.
First Name*
Middle Initial*
Last Name *
Email*
Please re-enter email to confirm*
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter as (###) ###-####
Please Re-Enter Phone Number to Confirm*
Please enter as (###) ###-####
High School Athletic Team*
Do you attend school at SAMi, SOTA, or iDEA? Please indicate below.
Cumulative GPA*
How Did You Hear About This Scholarship? *
If Other, Please List
Gender*
First & Last Name of Father or Guardian
First & Last Name of Mother or Guardian
WIAA Varsity Sport(s) Played (check all that apply)*

BaseballBasketballBowlingCross CountryFootballGolfGymnasticsSoccerSoftballSwim & DiveTennisTrack & FieldVolleyballWrestling
To be eligible for this scholarship, you must have participated on a varsity high school athletic team that engaged in interscholastic competition. Please list the calendar year(s) played (ie 2021, 2022), and head coach(es) name for the each of the sports marked above.*
Please list any volunteer/community service, extracurricular activities and/or offices you held in high school. Indicate the calendar year(s) for each one.
Please list all of the not-for-profit vocational & technical school(s), 2-year or 4-year college(s) you have applied to. Write "accepted" after any school that has already accepted your application. *
First Personal Reference Name*

First NameLast Name
First Personal Reference Phone Number*
Please enter as (###) ###-####
First Personal Reference Email*
example@example.com
Relationship to First Personal Reference*
Second Personal Reference Name

First NameLast Name
Second Personal Reference Phone Number
Please enter as (###) ###-####
Second Personal Reference Email
example@example.com
Relationship to Second Personal Reference
Participation in athletics significantly influenced the life of our founder, Ben B. Cheney. How has participation in athletics influenced your life? What life lessons have you learned through athletics?(300 words max) *

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2023 High School Scholarship Program Application

Complete applications due by March 15, 2023.