Scholarship Application

Name

Physical Address

Mailing Address

City

State:
North CarolinaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming

Home Phone Number

E-Mail Address

Date of Birth

Place of Birth

Gender
MALE FEMALE

FAMILY INFORMATION Parents/Guardian(s)

MOTHER

Mother's Full Name

Mother's Date of Birth

Mother's Address

Mother's Home Phone Number

Mother's E-Mail Address

Mother's Occupation

FATHER

Father's Full Name

Father's Date of Birth

Father's Address

Father's Home Phone Number

Father's E-Mail Address

Father's Occupation

EDUCATION: HIGH SCHOOL(S) ATTENDED

School / City / State / Dates of Attendance

ACTIVITIES and COMMUNITY INVOLVEMENT

ATHLETIC ACTIVITIES:

Please list all athletic activities in which you have participated during your high school career

Sports:

Letters won:

Special Sports Honors or Awards Received:

SCHOOL ACTIVITIES:

Please list all school activities in which you have participated during your high school career including clubs, student government, and other school organized activities.

Activities:

Positions of Leadership:

Special Honors or Awards Received:

Special Achievements:

COMMUNITY and RELIGIOUS INVOLVEMENT:

Please list any religious and community activities in which you have been involved during your high school career.

Activities:

Positions of Leadership:

Special Honors or Awards Received:

Special Achievements:

EMPLOYMENT:

Please list any employment you held during your high school career

Employer:

Position held:

Brief Job Description:

Dates of Employment:

SECOND JOB

Employer:

Position held:

Brief Job Description:

Dates of Employment:

ACADEMIC and PROFESSIONAL PURSUITS

What field of study do you plan to pursue?

Please list all colleges and/or universities you have applied to or plan to apply:

Name / City/ State / Status of Application

What career are you planning to pursue?

ESSAY PORTION

In a minimum of 1000 words, please discuss the following:

As a high school senior, you have been tasked with addressing the danger and consequences of underage drinking and driving as your senior project. This project is solely intended to raise awareness and offer solutions to this problem in hopes to deter anyone from participating in underage drinking and driving. Many upcoming festivities are likely to include the temptation of alcohol as you celebrate prom and your anticipated graduation, and the potential situations need to be addressed now. Your project will be presented in front of the entire high school and may be a speech, including data and statistics to support your case and offer solutions, present a program or invite a guest speaker. You MUST realize how important this project is, and know that your message has to be heartfelt and persuasive as you may make a difference in the lives of your fellow high school classmates.

HONOR PLEDGE

I completed this application on (date):

The Answers above are true to the best of my knowledge. The essay response is my own work.
TRUE

PLEASE REVIEW ALL FIELDS ABOVE AND PRESS THE BUTTON BELOW TO SUBMIT