MAC Scholarship Recipient - Student Profile
Your Information
Name
*
First Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Type of Phone Number
*
Cell Phone
Home Phone
Email
*
example@example.com
High School Attended
*
High School Graduation Year
*
High School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
High School Athlete
*
Yes
No
If yes, what sport
High School Extracurricular Activities:
Scholarship Received
*
College Year
*
Freshman
Sophomore
Junior
Senior
College Major
*
College Minor
College Athlete
*
Yes
No
If yes, what sport? Please include number of years on the team.
Parent Information
(where applicable)
Father's Name
First Name
Last Name
Father's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mother's Name
First Name
Last Name
Mother's Address (if different from father's)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Spouse/Children Information
(where applicable)
Spouse's Name
First Name
Last Name
Children's Name(s)
Current Employment
(where applicable)
Employer
Position
Employer's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Membership - MAC Clubs/Organizations
Club/Org Name
Years of Membership
Club/Org Name
Years of Membership
Club/Org Name
Years of Membership
Current or Previous Volunteer Service
Type/Place #1
Responsibilities
Type/Place #2
Responsibilities
Your Photo
A picture of you will be sent to your benefactor/representative along with your thank you letter and profile. Please upload a current professional photo of yourself. No selfies, proper apparel is necessary; no sports apparel, t-shirts, sweatshirts, revealing clothing or clothing with sayings or words. If you just graduated from high school, your senior picture should work. Head shots are acceptable.
Submit Your Photo Here
*
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