College Scholarship Application (for those currently enrolled in college)

Personal Information
Name *
Name
Primary Phone Number *
Primary Phone Number
Address *
Address
Date of Birth *
Date of Birth
School/Community Activity
Let us know about any activities (if any) you were involved in at school or within your community.
What other financial support, e.g., scholarships, grants, loans have you applied for?
$
Has this aid been received?
$
Has this aid been received?
$
Has this aid been received?
Dream of 10 possibilities:
List 10 things(large or small) that you would like to happen in the next few years, regardless of how possible or impossible you may think they are.
Work Experience
Date Started
Date Started
Dated Ended
Dated Ended
Date Started
Date Started
Date Ended
Date Ended
Date Started
Date Started
Date Ended
Date Ended
Do you plan to look for a part time job in order to earn some extra money while studying?
Confidential Financial Information
The funds available for financial aid are limited. In order to distribute the award in the most equitable manner, the applicants need for financial aid must be carefully evaluated. If you are independent (emancipated) from your parents, please give your own income. If married, include earnings of husband or wife. Please note that all spaces must be marked. If they are not applicable, mark them as such. Feel free to present further details on a separate sheet of paper.
Your Name (If emancipated)
Your Name (If emancipated)
$
Living with Parents?
Father's Name
Father's Name
$
Living in the home?
Mother's Name
Mother's Name
$
Living in the home?
Guardian's Name
Guardian's Name
$
Living in the home?
Please Review Application before submitting
NOTE: Pictures and information submitted on applications of students receiving scholarships may be used for future publicity. If you are satisfied with your application, click submit to send us your application!