Scholarship Application Form

SCHOLARSHIP APPLICATION FORM

All information provided will be regarded as confidential
Applicant Information
Name of Scholarship(s) Applying for:*
Applicant Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth:*

MonthDayYear
Age:*
Phone No.:*
Format: (000) 000-0000.

SCHOLARSHIP APPLICATION FORM

All information provided will be regarded as confidential
School Information
School Name:*
School Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Cumulative G.P.A.:*
Class Rank:*
Name of Principal:*
Name of Counselor:*

College(s)/Technical Program(s) applied:*

Rows	College(s) / Technical Program(s)	Accepted
1.
2.
3.

SCHOLARSHIP APPLICATION FORM

All information provided will be regarded as confidential
Financial & Household Information

Financial information is a primary factor for the Pearl Braxton Scholarship and a secondary factor for the Rodgers Scholarship.
Parent/Guardian 1 Name:*

First NameLast Name
Occupation:*
Parent/Guardian 2 Name:

First NameLast Name
Occupation:
Under $25,000$25,000–$49,999$50,000–$74,999$75,000–$99,999$100,000 and above
Applicants may be asked to provide verification (tax return, W-2, or similar documentation) prior to final award determination.
Number of siblings living in the home:*
Ages of siblings (brothers & sisters):*
Number of siblings currently enrolled in college:*
YesNo
Employer Name:*
Position:*
Average hours per week:*
Length of employment:*
Briefly describe any financial responsibilities you contribute toward your household:

SCHOLARSHIP APPLICATION FORM

All information provided will be regarded as confidential
School & Community Involvement Questionnaire

If a question does not apply, indicate "N/A."
1. High School Activities (list involvement, year participated, and any offices held):*
2. Community Service/ Civic Involvement (Include organization name, years involved, any leadership roles:*
3. Church Affiliation name and Involvement (if applicable):*
4. Awards and Honors (List award name and year received):*
5. List your Career Goals:*
6. Final college choice and intended major (if known):

SCHOLARSHIP APPLICATION FORM

All information provided will be regarded as confidential
Essay Requirements
250–500 words, double-spaced, 12-point. Include the scholarship name at the top.

If you apply for multiple scholarships you must answer the prompt question for each of the scholarships you’ve chosen.

Essay Prompts
Pearl Braxton Scholarship

0/500
Dorothy, Linwood & Linda Rodgers Scholarship

0/500
Eleanor Wynne Memorial Scholarship

0/500

SCHOLARSHIP APPLICATION FORM

All information provided will be regarded as confidential
File Uploads
Upload Transcript:*

Cancelof
Upload Recommendation Letters:*

Cancelof

SCHOLARSHIP APPLICATION FORM

All information provided will be regarded as confidential
Final Statement-Scholarship Requirements
I am submitting my application for the 2026 Chesapeake Club Ministry Scholarship Program.

I understand that incomplete or improperly submitted applications will not be reviewed.

If selected, I agree to provide an official final high school transcript and official proof of Fall 2026 enrollment no later than September 30, 2026, before scholarship funds are released.

I understand that additional documentation may be requested to verify eligibility.

I certify that the information provided in this application is true and accurate to the best of my knowledge.
Student Signature:*

Clear
Date:*

MonthDayYear
Parent/Guardian Signature:

Clear
Date:

MonthDayYear

Data

SCHOLARSHIP APPLICATION FORM