Scholarship Application

Step 1

First Name*

Middle Initial*

Last Name*

Sex*

Street Address*

City*

State*

Zip Code*

Email Address*

Phone Number*

Date of Birth*

Step 2

Parent / Guardian First Name

Parent / Guardian Last Name

Parent / Guardian Street Address

Parent / Guardian City

Parent / Guardian State

Parent / Guardian Zip Code

Parent / Guardian Phone Number

Step 3

Name of High School*

Cumulative GPA (4.0 Scale)*

Class Rank*

Percentage of Honors, AP, or Dual Credit classes*

Step 4

List any academic honors, awards, or membership activities while in high school

List your hobbies, outside interests, extracurricular activities and school related volunteer activities

Step 5

List your non-school sponsored volunteer activities in the community

Leadership Activities: List the level of responsibility in school, community, family, and your ability to influence others

Work Experience

Step 6

Have you decided on the college you will attend?*

College Choice*

College Choice #2 (if undecided)

College Choice #3 (if undecided)

Anticipated Field of Study

Step 7

Community Service Essay*

Describe how your community service came about and what being a volunteer has taught you. Which causes or organizations especially interest you and why? Finally, discuss any challenges you have dealt with and overcome and how this will help you succeed in college and beyond (400-600 words).

Step 8

Select a partner organization for the matching contribution*

You may choose from local organizations supporting bicycle safety or local soccer programs.

Bicycle Safety Soccer Programs

Step 9

Please check the following box to confirm you are ready to submit your application.*

I have reviewed all my answers and I am ready to submit my application for review.