Delaware County Athletic Hall of Fame Scholarship Application Form
Last Name
*
First Name
Middle Initial
Street Address
City
State
Email Address
example@example.com
Birthdate
/
Month
/
Day
Year
Date
Home Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Post Secondary School you plan to attend
Have you applied to a post secondary school?
Yes
No
Have you been accepted?
Yes
No
Anticipated major course of study
Father's name
Mother's name
The name of your relative who is a member of the Delaware County Athletic Hall of Fame:
Name (Printed)
*
Relationship (previous question)
*
Son/Daughter
Gradson/Granddaughter
Nephew/Niece
Student's Signature
Date
/
Month
/
Day
Year
Date
Parent's Signature
Date
/
Month
/
Day
Year
Date
Member/Survivor Signature
Date
/
Month
/
Day
Year
Date
Class Rank
GPA
SAT
Verbal
Math
Writing
Total
ACT Comp
Counselor's Name
Counselor's Signature
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