The Hannah Stailey Memorial Scholarship Application Form

The Hannah Stailey Memorial Scholarship Application Form

Revised by the HCYC Board of Directors April 2024
Name*

First NameLast Name
Phone Number*
Email*
example@example.com
Age*
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Mailing Address Line 2

CityState / Province

Postal / Zip Code
Name of High School Attended*
High School Diploma?*

YesNo
Academic awards and/or honors you received in High School*
Are you a member of any organization in your school? (Sports, Clubs, etc.)*
Work history (if applicable)
College or trade school attending*
Degree or trade pursuing*
Did you attend HCYC as a youth?*

YesNo
Church Affiliation*
Hobbies*
I CERTIFY THAT ALL STATEMENTS OR INFORMATION I HAVE PROVIDED ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I ALSO CERTIFY THAT I HAVE READ THE SCHOLARSHIP QUALIFICATIONS HERE. ANY DELIBERATE MISREPRESENTATION FOUND IN THIS APPLICATION MAY BE CAUSE FOR THE REMOVAL OF THIS APPLICATION AND MAY PROHIBIT ME FROM APPLYING AGAIN IN THE FUTURE.
Name of Applicant*

First NameLast Name
Applicant's Signature*

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Date Signed by Applicant*

MonthDayYear
Date
Should be Empty: