WCCC Scholarship Submission Form

Women’s Club of Coconut Creek Scholarship Application

You must complete all of the requirements below. DEADLINE: MARCH 28, 2025
Name*

First NameLast Name
Birth Date*

MonthDayYear
Career of Interest *
Alternate Career of Interest
High School Attending*
Phone Number*
E-mail*
example@example.com
Are you in the Women’s Club of Coconut Creek Mentorship Program?

YesNo
1. Video Submission

Videos must be 2-5 minutes in length
Your video submission should be 2-5 minutes in length and must answer the following questions:

1. What are your future career and educational goals? Be specific to YOUR goals and dreams for YOUR future.

2. What are you passionate about? What kinds of things are important to you? Be descriptive and include specific examples.

3. What motivates you to be successful? What does success look like to you?

*Be honest, descriptive, and genuine in all of your answers.

PLEASE NOTE: Applicants may use written outline notes but CANNOT be reading word for word from a script.

PLEASE VIEW THE RUBRIC BELOW TO SEE THE CRITERIA THAT OUR PANEL OF JUDGES WILL USE TO SCORE YOUR SUBMISSION!
Upload Video Submission Here

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I do hereby certify that all information in this video is true and correct to the best of my knowledge.

I do hereby consent to the use of this video by the Women's Club of Coconut Creek on Facebook, Instagram, or website, or in any other promotional ways related to the club.

By signing below, I agree to the above statements.
Signature*

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Date*

MonthDayYear
Date
2. References Required!

Select 2 individuals who can write a reference on your behalf.
You must provide contact information for two references.

Reference 1: will be from an adult (ie. coach, teacher, employer, mentor).

Reference 2: will be from a peer (ie. classmate, teammate, coworker, friend).

Please provide the requested information below.

PLEASE NOTE:

The reference letter CANNOT be submitted by anyone other than the person who is writing the reference. The applicant may NOT assist with writing the reference letter on their behalf.
Adult Reference Email
example@example.com
Adult Reference Phone Number
Link to Adult Reference Form:

https://form.jotform.com/241665860242154
Peer Reference Email
example@example.com
Peer Reference Phone Number
Link to Peer Reference Form:

https://form.jotform.com/241666089416161
3. Book an Interview Date

Book an interview date by MARCH 28, 2025. The dates available for interviews are TBA, please check back for information on how to book. Interviews will be conducted in April.
You must book a date and complete an in-person interview presentation on the following topic:

Share a special moment in community service that is personal to you and the community of Coconut Creek. Explain how your service positively impacted the community. Explain how the act of service positively impacted you personally.
4. Upload Academic Documentation

Complete questions and upload documents at the following: https://form.jotform.com/241666152898166
Contact:

Scholarships@womensclubcoconutcreek.com with any questions or concerns
Should be Empty:

Women’s Club of Coconut Creek Scholarship Application

1. Video Submission

2. References Required!

Link to Adult Reference Form:

Link to Peer Reference Form:

3. Book an Interview Date

4. Upload Academic Documentation