Sixteen Pearls Scholarship Application

Scholarship Application
Applicant Information
Name*
Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Email*
Name of Parents or Guardians*
Place of Employment/Occupation of Parents or Guardians*
Combined Yearly Income*
YESNO
Number of family members living in the household*
Number of family members in college living in the household*
Note any special circumstances that would affect your family’s financial situation*
Academic Information
Name of High School:*
GPA*
List your extra-curricular school activities (sports, music, clubs, etc.)
Activity*
Years of Participation*
Position Held*
Activity*
Years of Participation*
Position Held*
Activity*
Years of Participation*
Position Held*
List honors and awards received in school or the community (Honor Society and/or Community Awards, etc.)*
List any volunteer and/or community service*
YESNO
YESNO
YESNO
If so, please give the amount of scholarships and financial assistance awarded in total*
Please list the Colleges and Universities to which you have applied.
College/University*
Location*
YESNO
College/University*
Location*
YESNO
College/University*
Location*
YESNO
Other Information

Indicate any employment in which you have been engaged
Places of Employment*
Dates Employed - Start

MonthDayYear
Dates Employed - End

MonthDayYear
Date
Amount Earned
Places of Employment*
Dates Employed - Start

MonthDayYear
Dates Employed - End

MonthDayYear
Date
Amount Earned
Places of Employment*
Dates Employed - Start

MonthDayYear
Date
Dates Employed - End

MonthDayYear
Amount Earned
Before submitting, please check to make sure you have included:
- Your application
- Your Official Transcript
- SAT/ACT Scores
- Your Essay
- Letter of Recommendation
- Photo
File Uploads
Upload Official Transcript*

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Upload SAT/ACT Scores*

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Upload Your Essay*

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Upload Letter of Recommendation*

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Upload Your Profile Pic*

Please upload a professional headshot in .jpg format.
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Sign & Date
By signing this form, you are indicating that the information provided is correct and truthful to the best of your
knowledge.
Signature of Applicant*

Clear
Date*

MonthDayYear
You have the option to save and continue later. If you do so, please check your email for instructions.

Once you hit submit, your application submission will be final.
Should be Empty:

Scholarship Application

Applicant Information

Academic Information

Other Information

Before submitting, please check to make sure you have included:

File Uploads

Sign & Date