CCS Scholarship Application Form

CCS Founders Scholarship Application

2023-2024
PERSONAL INFORMATION
Full Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender:*

MaleFemale
Home Address*
City*
State*
Zip Code*
Phone Number

Area CodePhone Number
Mobile Number*

Area CodePhone Number
E-mail*
Father's Name*
Mother's Name*
Church you attend (optional)
HIGH SCHOOL INFORMATION
High School Attended*
Graduation Date*

MonthDayYear
Date
GPA*
Upload High School Transcripts*

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SAT Score*
ACT Score*
Academic Honors Received
Extracurricular Involvement
COLLEGE / UNIVERSITY INFORMATION
College/University you've been accepted to
Upload acceptance letter*

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Major you plan to pursue
SCHOLARSHIP ESSAY
Please submit an essay along with your application for us to get to know you better and understand how this scholarship will impact you.
Upload essay

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CONFIRMATION
I hereby certify that the information on this application is complete and correct to the best of my knowledge. I hereby grant permission to the Capital City Steppers to verify all information listed on this application. If necessary, permission is also given to the Capital City Steppers to use my name, likeness and photograph in promotional materials and public announcements in the event that I am selected to receive this scholarship.
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Electronic Signature*
(Type your full name)
**NOTE: Application must be accompanied by a minimum 250 word essay stating why you chose to pursue your intended major concentration, what motivation led to your decision and what you hope to contribute to society as a result of earning a degree in this area.

You may email application to admin@capitalcitysteppin.net or mail to Capital City Steppers, P.O. Box 61132, Raleigh, NC 27661-1132.
Confirm your identity*
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CCS Founders Scholarship Application

PERSONAL INFORMATION

HIGH SCHOOL INFORMATION

COLLEGE / UNIVERSITY INFORMATION

SCHOLARSHIP ESSAY

CONFIRMATION