General Scholarship Application

Doogilvie Scholarship Application Form

Living Hope SDA Church (formally Croton Falls) | 331 NY -100, Somers, NY
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Mobile Phone Number*
E-mail*
Enter E-mail Here
Address*

Street Address

Apt/Unit #

CityState

Zip Code
Name of School*
Grade Level*
School Address*

Street Address

CityState

Zip Code
School Phone Number*
Please enter a valid phone number.
School Email
example@example.com
Current Cumulative GPA or Attach Proof of Grades
Optional Note Regarding GPA (Some students struggle with the transition from middle school to high school. Greater emphasis will be placed on grades made from 10th-12th grades).
Community Service
Name of Institution or person with whom this is done*
Number of hours of service*
Explanation of service rendered*
Parent(s)/Guardian Information & Financials
Name - Parent/Guardian 1*

First NameLast Name
Name - Parent/Guardian 2

First NameLast Name
Address*

Street Address

Apt/Unit #

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Employment Status*
Name of Employer - Parent/Guardian 1*
If employed*
Name of Employer - Parent/Guardian 2
If employed*
Household Income*

Less than $20,000$20,000 - $50,000$50,000 - $100,000More than $100,000
Description of Financial Need*

0/600
Include below contact information of two references (Names, Emails, Phone #'s)*

0/600
Signature of Applicant

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Upload Grades (Copy of Report Card) *

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Upload Optional Reference Letter

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Doogilvie Scholarship Application Form

Community Service

Parent(s)/Guardian Information & Financials