2026 D.E.B. Life Scholarship Application Form

2026 D.E.B. Life Scholarship Application Form

2026 D.E.B. Life Scholarship Application Form

Once a DEB, always a DEB!
Name

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

MonthDayYear
Date
Gender

MaleFemalePrefer not to say
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
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
Activity 4
Activity 5

List your community service activities and volunteer work.

	Organization	Position/Role	Duration
Activity 1
Activity 2
Activity 3
Activity 4
Activity 5

List any awards or honors you have received.

	Name	Description	Date
Award 1
Award 2
Award 3
Award 4
Award 5
Award 6
Award 7

Parent/Guardian Name

First NameLast Name

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.
Applicant's Signature

Clear
Date signed

MonthDayYear
Date
Should be Empty: