Scholarship Application

Name of Applicant

First NameLast Name

Scholarship Applying For

Student ID

Date of Birth

Date

Home Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address

example@example.com

Home Phone Number

Format: (000) 000-0000.

Mobile Phone Number

Format: (000) 000-0000.

Classification of Student

Hours Completed

GPA

Clubs and Organizations

Are you a first-generation student?

Are you a member of the ACE Program?

What 4-year degree are you pursuing?

Name of the immediate relative who is an alumna/alumnus of the University of Pikeville

First NameLast Name

Amount Requested

Reason for Request

Copy of your bill

Browse Files

Essay (per requirements)

Browse Files

By signing below, I certify that the information provided in this scholarship application is true, complete, and accurate to the best of my knowledge. I understand that providing false, incomplete, or misleading information may result in disqualification from scholarship consideration or revocation of any scholarship award.

I also acknowledge that submission of this application constitutes acceptance of any terms, conditions, and requirements associated with this scholarship program.

Please sign below to confirm your agreement.

Signature

Date