PEERS SCHOLARSHIP APPLICATION FORM

PEERS SCHOLARSHIP APPLICATION FORM
Thank you for your interest in the PEERS Project Scholarship Contest. Please fill out the below form completely, along with emailing a letter of reference from two different people to Bethany May at bmay@peersproject.org. Please include your name, email and school name with your attachments.
Student Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
GPA*
Graduation Date*
Years Participated in PEERS program:*
List extracurricular activities in which you have participated:
List honors/awards/recognitions:
Are you employed?

YesNo
If employed, list where:
College or vocational school you plan to attend this fall, include major (if chosen):
What are your future career goals?
Please provide name and addresses for two references. Email letters of reference from each person to bmay@peersproject.org .
Additional support in support of your application.
Use the space below to write an essay on the importance of making healthy choices and wise decisions. (250-500 words)
By completing the digital signature section below, you affirm that the information submitted on this form is true and that the student's name and photograph may be used by The PEERS Project for public relations purposes.

Someone will be in contact with you soon.

Thank you!

PEERS Project Staff
Student Full Name*
Signature*

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Parent/Guardian Full Name*
Signature*

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