Leadership Scholarship Application

Leadership Scholarship Application

Elder Mother Cristeen Horton Leadership Award
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender

Other
High School Name
High School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Grade Level
Expected Graduation Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Cumulative GPA
Why are you applying for this scholarship?
Essay (250-500 words)
What Leadership qualities have you exemplified during your high school tenure that reflect the legacy of Elder Cristeen Horton?
Essay (250-500 words)

List your extracurricular activities, including sports, clubs, and organizations:

List your community service activities and volunteer work

Rows	Organization	Position/Role	Duration
Activity 1
Activity 2

List any awards or honors you have received

Rows	Name	Description	Date
Award 1
Award 2

Academic Reference

Rows	Name	Position	Contact Information
Reference

Academic Reference

Rows	Name	Position	Contact Information
Reference

Personal Reference

Rows	Name	Position	Contact Information
Reference

Applicant's Declaration

I hereby declare that the information provided in this application is true and accurate to the best of my knowledge. I understand that any false information may result in the disqualification of my application.
Applicant's Signature
Date signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: