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Buckeye Scholarship Foundation Application

Be sure to have all documentation and member numbers before beginning
Student Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student is a Member of one of the Following:

AHEPADaughtersSonsMaidsNone
Chapter Affiliation
Initiation Year
Current Date

MonthDayYear
Date
Numeric Year
Initiation
Membership Number

Parent or Guardian Information
Name of Parent or Guardian that is a Member of the AHEPA or Daughters

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent or Guardian Chapter Affiliation
Parent or Guardian's Member Number

Awards Received - Maximum 5

Extra-Curricular Activities

	Activity Description	Number of Years Participated	Leadrship Position
Activity 1
Activity 2
Activity 3
Activity 4
Activity 5

College to Attend in the Fall
Must be the complete name of the college - NO abreviations
Preferred Major
Upload Transcript*

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For Graduating High School Seniors, Upload a College Letter of Acceptance

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Total Points for Student
Should be Empty:

Buckeye Scholarship Foundation Application