RGC Scholarship Signup Form
ABOUT ME
Name
*
First Name
Last Name
School / College Name
Aspirations
e.g., become a doctor, lawyer, engineer, athlete, etc.
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MY FAMILY & SUPPORT SYSTEM
I come from a tight-knit community that values education, hard work, and perseverance. Their guidance has shaped me into the person I am today.
Mother Name
First Name
Last Name
Achievements/Background
Father Name
First Name
Last Name
Achievements/Background
Siblings
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Other influential Adults in Benefactor’s Lifer [i.e. Guardian, Grand Parents, Aunt, Uncle, Mentor(s)]
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HOW I GIVE BACK TO MY COMMUNITY
I believe in the power of giving back and making a difference in the lives of others. Here are a few ways I’ve contributed to my community:
Community Initiative #1
Brief Description
Community Initiative #2
Brief Description
Community Initiative #3
Brief Description
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MY ACADEMIC, ATHLETIC, & or OTHER NOTEWORTHY ACCOMPLISHMENTS
I am proud to have achieved the following milestones in my academic and extracurricular journey:
School Name
Accomplishments
e.g., GPA, Honors, Awards
Athletics/Extracurriculars (if applicable)
High School/AAU Accomplishments
Committed to College/University Name
Post secondary education aspirations
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MY GOALS & ASPIRATIONS
Personal/Career goal
e.g., attend college, pursue a specific profession, excel in sports, etc
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Contact Information of Submitter
Name
*
First Name
Last Name
Email
*
example@example.com
Relationship to Benefactor
*
Photo of Benefactor
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Benefactor must be 18 years or older, otherwise must be signed up by a legal parent or guardian.
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I confirm that I am authorized to submit this form on behalf of benefactor.
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