Scholarship Form

Application for Scholarship Grant- CONFIDENTIAL -
Your Application will only be sent to the Scholarship Committee

Name of Applicant

Date

Permanent Address

Temporary Address

Father's Name

Father's Occupation

Father's Phone Number

Mother's Name

Mother's Occupation

Mother's Phone Number

Number of Dependent Children in House

Number of Dependents Grade 12 or Below

Number of Dependents in College

Applicant's High School

Year of Graduation

Cumulative GPA

Applicant's College

Major

Year of Graduation

Cumulative GPA

High School Honors

College Honors

Statement of Career Goal

Estimated Tuition Per Year

Estimated Travel Costs Per Year

Estimated Student Fees Per Year

Estimated Board & Lodging Fees Per Year

Estimated Clothing Fees Per Year

Estimated Recreation Fees Per Year

Total Estimated Yearly Cost

Additional information deemed necessary by applicant

Please type name to agree with the following statement: I understand this grant will be used for tuition only and in the event that I do not enter school, I will return said grant.

Scholarship Form

Application for Scholarship Grant- CONFIDENTIAL -Your Application will only be sent to the Scholarship Committee

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Application for Scholarship Grant- CONFIDENTIAL -
Your Application will only be sent to the Scholarship Committee