Bill T. Hicks Scholarship Application

Bill T. Hicks Scholarship Application

Presented by Y-12 Federal Credit Union
Student Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
Are you currently a member? If no, you must be a member prior to receiving the scholarship.*

YesNo
Parent's Name*

First NameLast Name
Parent's Email*
example@example.com
Parent's Phone Number*
Please enter a valid phone number.
Academic Information
High School Information*
List any school activities (sports, clubs, etc.), any positions you have held, and how long you have participated.*
List any community service (church, volunteer, etc.), any positions you held, and estimated hours of service.*
List any employment history, including your current employer, if applicable.
List all awards, honors, and achievements, as well as the date received. This includes any community or school related awards.*
I hereby certify that all information is correct, to the best of my knowledge. I will also submit all documents necessary for the application as laid out by the Bill T. Hicks Scholarship Guidelines. I understand that the application is the property of Y-12 Federal Credit Union. If selected, I agree to allow my name and photo to be used in promotional materials by Y-12 Federal Credit Union.
Student Signature*

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Parent or Guardian Signature*

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Date

MonthDayYear
Date
Should be Empty:

Academic Information