Poplar Bluff Senior High Scholarship
Full Name
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First Name
Last Name
Last Four Digits of SSN
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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E-mail
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example@example.com
Birth Date
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Month
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Day
Year
Date
Name of Parents
Sophomore Year GPA
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Junior Year GPA
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Senior Year GPA
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Overall GPA
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If your grades improved or dropped from one year to the next, please briefly explain:
Favorite High School Instructor (Please briefly explain):
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I have applied for admission to:
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Plan of Study:
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School Councilor
For the 2025 Fall - 2026 Spring Academic Year I plan to enroll:
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Please Select
Full-time (12 or more hours per semester)
Half-time (6-11 hours per semester)
Less than half-time (1-5 hours per semester)
ACTIVITIES & HONORS
(List the most important activities/honors within the last two years)
Civic Activities (Humanities activities, The Arts – Literature, Theater, etc):
School Activities:
Offices Held:
Honors Awarded:
TEACHER RECOMMENDATION
A general teacher recommendation is requested with this application. Please ensure that the recommendation is sealed and attached to your application with your name labeled on the front. Please give your teacher appropriate time to meet the deadline date.
ESSAY
An essay is required. It must be typed and no longer than one page. Your name must be typed in the upper right corner. Neatness, spelling, and grammar are very important. Questions to address in essay: What are your career and community goals? If you receive this scholarship, how will it help you achieve your goals?
COMMUNITY SERVICE
Describe any community service or service projects you have been involved with in the last three years.
Upload essay, counselor recommendation, and letter of reference.
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With my signature I certify that all information provided is to the best of my knowledge true and complete and I have not willingly or knowingly withheld information.
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