It's Your Responsibility Scholarship Application

Creative Change Counseling Inc.

609-667-7353

www.creativechangeinc.org
"It's Your Responsibility" Scholarship Application Form

Application Deadline - Midnight on March 15, 2024
We're excited to offer five $5,000 scholarships to support students on their educational journey. These scholarships are designed to empower and uplift aspiring individuals who are committed to making a positive impact in their communities.
Read and follow the instructions carefully prior to submitting your application. All winners will be notified by the 20th of April 2024.
I. Personal Data

Tell us about yourself
Full Name*

First NameLast Name
Mobile No*
Email *
Where the confirmation will be send to
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which Scholarship are you interested in applying for?

"It's Your Responsibility" Scholarship in Honor of Christian Jackson"It's Your Responsibility" Scholarship in Honor of Christian Jackson CONTINUING EDUCATION
II. High School Information
Are you or will you be a May 2024 high school graduate?

YesNo
High School Attended
Year of High School Graduation or GED
Most recent cumulative GPA
High School activities, community activities, volunteer work, honors, offices held
V. For Students Currently Enrolled in College
Approximate credit hours completed by May 2023
Current GPA
VII. Supporting Documents

One essay, two letters of recommendation, proof of acceptance and your 3-5 minute video are required to complete your application. If you are not able to upload all items at one time, you may submit the application, and email your supporting documents to scholarshipcommittee@creativechangeinc.org. **Please note your scholarship application will not be considered until all items have been received.
Please Upload Your Essay*

Cancelof
Please Upload Your 3-5 Minute Video*

Cancelof
Please Upload TWO Letters of Recommendation

Cancelof
Please Upload Your Proof of Acceptance or Enrollment

Cancelof
VIII. Applicant's E-Signature
By signing the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
Signature

Powered by Jotform SignClear
Creative Change Counseling is committed to equal opportunity in education. The Agency does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
Should be Empty:

"It's Your Responsibility" Scholarship Application Form

I. Personal Data

II. High School Information

V. For Students Currently Enrolled in College

VII. Supporting Documents

VIII. Applicant's E-Signature