Scholarship/Financial Assistance Program Application

Applicant’s Name _________________________________________/____________/___________________________________

                   (First)                                                (Middle)                               (Last)

Address:_______________________________________/_______________________________/_________

How long have you lived in this area?   _____________________________(years)(months)


Telephone:______/_________________ Email__________________________________________________


Last 4 digits of Social Security Number:         XXX-XX-____________________


School Currently Attending:______________________________________________________________

2 year _____ or 4 yr program____


Cumulative Grade Point Average: _________(weighted) ________(unweighted)


What do you plan to study and why? (Attach additional sheets if necessary)


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Briefly describe your life goals:

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List any honors you have received:

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Describe extracurricular activities, volunteer efforts, and any advance placement courses.


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