Piggott Chamber of Commerce Scholarship Application Form

Piggott Chamber of Commerce Scholarship Application Form

The Chamber of Commerce Board of Directors prioritizes community involvement, leadership, and character, while still considering academic achievement and financial need during their selection process. Applications will be scored based on a rubric emphasizing these qualifications. To view the details of the rubric, please visit our website.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Cumulative GPA*
Composite ACT Score*
Do you currently work?*

YesNo
If yes, where do you work?
Number of hours worked per week?

Less than 1010-2020-3030-40
What college do you plan to attend?*
Have you applied?*

YesNo
Have you been accepted?*

YesNo
Anticipated total school cost for next year?*

Less than $2500$2500-$5000$5,000-$10,000More than $10,000
Do you plan to work while attending college?*

YesNo
Family Household Income*

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

List your offices and/or positions of leadership held during high school (9-12 grades), including sports, clubs, and organizations:

List up to 5 awards or honors you have received during your high school career. (9-12 grades)

List up to 5 of your extracurricular activities, including sports, clubs, and organizations:

List up to 5 of your community service activities and volunteer work during your high school career. (9-12 grade)

	Organization	Type of service/volunteer work	Duration
Activity 1
Activity 2
Activity 3
Activity 4
Activity 5

What is the accomplishment you are most proud of in life so far?*
Essay (250-500 words)
Describe a time you faced a struggle or challenge and how you were able to overcome it.*
Essay (250-500 words)
How has your school and community involvement prepared you for future endeavors?*
Essay (250-500 words)
Where do you see yourself in five years?*
Essay (250-500 words)
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

Powered by Jotform SignClear
Date signed

MonthDayYear
Date
Should be Empty: