Name of college, business school, technical school, junior college or other school you plan to attend: ________________________________________________________________________________
Have you been accepted for admittance at this time? _____________________________________
Intended major: ___________________________________________________________________
Briefly explain how or why you selected the above major:
__________________________________________________________________________________________________________________

Please list all of the high school/community-related activities in which you have been engaged and the years of participation. Also, include any employment history
you may have. Attach additional sheet of paper, if necessary.
____________________________________________________________________________________________________________________

List special recognition, prizes, contest or honors that you have received in the school or community:
_______________________________________________________________________________________________________________________

Write a brief essay explaining why this scholarship is important to you.  Attach an additional sheet of paper, if necessary.

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

**** All of the information in this application will be kept in the strictest confidence.****  

A copy of my transcript is attached to this application for the screening committee to study.

Counselor’s Signature: _________________________________ Date: _________________________