Zeta Amicae of Las Vegas High School Scholarship Application Form

Zeta Amicae of Las Vegas High School Scholarship Application Form
Name

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

MonthDayYear
Date
Gender

MaleFemaleOther
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
High School Name
High School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Grade Level

FreshmanSophomoreJuniorSenior
Expected Graduation Date

MonthDayYear
Date
Cumulative GPA
Why are you applying for this scholarship?
Essay (250-500 words)

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

	Name	Position/Role	Duration
Activity 1
Activity 2
Activity 3

List your community service activities and volunteer work

	Organization	Position/Role	Duration
Activity 1
Activity 2

List any awards or honors you have received

	Name	Description	Date
Award 1
Award 2

Parent/Guardian Name

First NameLast Name
Parent/Guardian Occupation
Household Income

Less than $20,000$20,000 - $50,000$50,000 - $100,000More than $100,000

Academic Reference

	Name	Position	Contact Information
Reference

Personal Reference

	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. Please upload a clear headshot of yourself, along with 2 letters of recommendation, transcripts, and college or trade school acceptance letter.
File Upload

Cancelof
I hereby grant Zeta Amicae of Las Vegas permission to capture and use photographs, videos, or other media of me for promotional, educational, and informational purposes. This includes, but is not limited to, use in print materials, social media, websites, and other public communications. I understand that these images may be used without further notification or compensation and that [Organization Name] will handle the materials responsibly. By signing this release, I waive any rights to review or approve the finished product and agree to hold Zeta Amicae of Las Vegas harmless from any claims related to the use of these images.
Applicant's Signature

Clear
Parent/Guardian Signature

Clear
By signing below, I certify that all the information provided in this scholarship application is accurate and complete to the best of my knowledge. I understand that any false statements or omissions may disqualify me from consideration. Additionally, I agree to abide by the terms and conditions of the scholarship if selected.
Parent/Guardian Signature

Clear
Parent/Guardian Signature

Clear
Date signed

MonthDayYear
Date
Please verify that you are human*
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