Form

Read and follow the instructions carefully prior to submitting your application. You will be notified on or before the 28th of April 2017.

Read and Understand the instructions. *

Yes, I have

If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.

Full Name *

Prefix First Name Middle Name Last Name

Social Security Number : *

(e.g. 123456789)

Birthdate: *

Month Day Year

Mobile No. : *

- Area Code Phone Number

E-mail : *

Where the confirmation will be send to

Home Address : *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Optional Informations :

Information regarding gender, ethnic origin and race are optional. The information is requested for post-scholarship report generation only and in no way affects your application. However, providing this information may increase your opportunities for scholarships where donors have asked that priority consideration be given to students meeting certain demographic criteria (such as minority status, parent's place of employment, area of study, etc.)

Gender:

Male Female

Are you a US citizen?

Yes No

Ethnic Origin:

Hispanic Non-Hispanic Not Indicated

Race? (Choose one or more):

White Black or African American Asian American Indian or Alaskan Native Hawaiian or Other Pacific Islander Non-Resident Alien

Please check veteran status (Check all that apply)

Veteran Child of a Veteran Grandchild of a Veteran Spouse of a Veteran None of the Above

Status at the time of application:

I will be an incoming freshman graduating high school prior to 2021 I have attended college but have less than 32 college credit hours I have attended college but have at least 32 or more college credit hours I am a GED graduate with no college credit hours

Are you a first generation college student ?

Yes, I am the first among my parents or grandparents to attend college. No, either my parents or grandparents have attended college.

Desired Area of Focus:

Please indicate what is your major are of study

What is your Career Objective:

0/300

High School activities, community activities, volunteer work, honors, offices held:

By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.

E-Signature: *

Po' Shines Catering & Culinary Clinic is committed to equal opportunity in employment and education. The Clinic does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.

Privacy Policy:

The Sites’ contact forms request that users provide contact information (such as their name, mailing address, telephone number and e-mail address). We use contact information to send the user additional information about our schools and/or partners. A user’s contact information may also be used by us to contact the user directly. We do not sell or rent your contact information to third parties except when required to disclose such information by law or in response to request from a law enforcement agency or authority.

In compliance with the Children’s Online Privacy Protection Act, 15 U.S.C., Sec. 6501-06 and 16 C.F.R., section 312.1-312.12, our Sites do not permit children under 13 years of age to become users, and we do not collect information from children. By using our Sites, you represent that you are not under 13 years of age.

Except with regard to any contact information you may provide us via the Sites, all comments, feedback, information or materials submitted to Teach Me To Fish, CDC through or in association with this website (collectively, “Feedback”) will be considered non-confidential and the property of Teach Me To Fish, CDC. By submitting such Feedback to Teach Me To Fish, CDC, you agree that you assign to Teach Me To Fish, CDC, without charge, all worldwide rights, title and interest, including copyrights and other intellectual property rights, in and to the Feedback. should be free to use such Feedback on an unrestricted basis.

Personal Data:

Applicant's E-Signature