Scholarship Application Complete the Scholarship form below . Student Information First Name Middle Name Last Name Suffix Address City State Zip Code School Details Name of university or college you plan to attend What is your intended major? Have you been accepted? Yes No Academics Grade Point Average Did you attend on a regular basis? Yes or No ( If no explain why ) Name of High School counselor Phone number of High School counselor Are you in need of prom assistance ? Yes No Do you receive free and or reduce lunch from your High School? Yes No Have you applied for any other scholarships? Yes No Have you completed any community service activities? Yes No Have you been ordered to complete juvenile community probation? Yes No If yes what County Personal Statement Two letters of recommendations, college acceptance letter. ( PDF) Face Photo Date By submitting this application, I understand that completing the application does not guarantee I will be awarded the scholarship. I acknowledge that after submission, I will be scheduled for an interview with a committee of community leaders. Furthermore, if selected as a scholarship recipient, I agree to sign a photo and story release waiver to allow the organization to use my image and personal story for promotional and informational purposes. Submit
