First Name*:

Last Name*:

Gender:
---malefemale

Date of Birth:

Address:

City:

State:

Zip:

Phone:

Your Email:

Student Status:
---JuniorSenior1st Year of College2nd Year of College

Expected Diploma or Degree:
---DiplomaDegree

Educational Goals:

Course of Study:

Current GPA:

High School you are graduating or graduated from:

Expected Graduation Date:

List your parent full name:

Parent E-mail address:

Parent phone number:

What is the size of your household?

What is your household income? yearly

Do you live in a single parent home?
yesno

Colleges you’ve been accepted to:

College you plan to attend:

In the space below, tell us why Service to your family, community and friends is important.

Tell us how you have served in your community. Be as detailed as possible, naming volunteer organizations, your role(s), and how many days a week you serve. How has serving your community helped you as a person? What has it taught you about yourself?

List any paid jobs you hold outside of school; if applicable.

How would this scholarship help you in furthering your education?

How do you define Leadership? What does a Leader mean to you?

How do you plan to influence the world in a positive way?

List any awards or accolades you’ve received: (Honor Society, Sports, Community Services, etc.)

Attach letter of recommendation (Coach, Mentor, Counselor, Teacher/Faculty)

Attach a headshot to be included with your profile