Scholarship Application Form

Dawn Busters Kiwanis

Scholarship Application Form
Name *

First Name Last Name
E-mail *
Phone Number *
Address *

Street Address

Street Address Line 2

City State

Zip Code
Birth Date *

Month Day Year
Date
Sex *

Female Male
Mother's Name *

First Name Last Name
Father's Name *

First Name Last Name
School *
GPA *
Years in Key Club *
Describe your involvement with Key Club *
Service Hours

Service Hours at Dawn Busters Activities *

	Crescent City Classic	Golf Tournament	Lafreniere Easter Egg Hunt	Lafreniere Trunk/Treat	Turkey Fry	Other	Total
Freshman Year
Sophomore Year
Junior Year
Senior Year

Names of the Other Dawn Busters Activities
Other Activities with Dawn Busters

Service Hours at Key Club Activities *

	Service Hours
Freshman Year
Sophomore Year
Junior Year
Senior Year
Total

Service Hours at Non-Key Club Activities *

	Service Hours
Freshman Year
Sophomore Year
Junior Year
Senior Year
Total

Total Hours at Dawn Busters Activities
(Automatically Filled)
Total Hours at Key Club Activities
(Automatically Filled)
Total Hours at Non-Key Club Activities
(Automatically Filled)
Total Service Hours
(Automatically Filled)
What College/Institution do you plan to attend? *
What major(s) are you considering? *
What additional information about yourself would you like to share with the selection committee?
Application Date *

Month Day Year
Should be Empty:

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