NOTE: Some questions below, if you prefer, need not be answered. However, a complete evaluation of your application can be made in direct relation to the amount of information you provide.

• Full Name *
• Date of Birth *
• Address *
• Phone Number *
• High School
• Graduation Year
• GPA
• Father's Name
• Occupation
• Mother's Name
• Occupation
• Approximate Yearly Family Income
• Number of Siblings
• How many sibling live at home?
• How many siblings are in college?
• Are you working at Present?
  Yes No
• Type of work
• Employment Type
  Full Time Part-Time Temporary
• Previous Employment (last 3 years)
• For what business or profession are you preparing?
• How do you plan to further your education after you freshmen year?
• List your activities during high school
• Any other community activities?
• Where do you plan to attend school?

References

Please list three character references (High School Counselor, Teacher, Banker)

Reference #1

• Name
• Occupation
• Address

Reference #2

• Name
• Occupation
• Address

Reference #3

• Name
• Occupation
• Address

• Please give a brief resume of your education background, including any awards you have received. Add any other pertinent information about yourself, such as why you would like to receive this grant.

Supporting Documents

I affirm the correctness of the information provided in this application. I understand that I must register for and complete at least 12 credit hours. I understand that courses elected for "audit" credit will not be counted toward this minimum. I will notify the Scholarship Committee if it is impossible for me to maintain this minimum.