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Before filling out this form, please read the eligibility criteria.
Full name
Major
Phone number
Email address
High school name
High school address
ACT score
GPA on a scale
Class rank out of
Please list any organizations in which you were involved in high school, along with the year(s) when you were involved. You may also list organizations that were not necessarily associated with your high school.
Organizations
Please list any offices to which you were elected in high school, along with the year in which you served the office.
Elected offices
Please list any athletic involvement during high school. Include your highest level of involvement with your team (i.e. Varsity football team, starting wide receiver).
Athletics
Please list any honors, scholarships, or awards you may have received during high school. Include academic, athletic, and extracurricular achievements.
Honors
Please list your work experience, including your employer, your title, the number of hours worked per week, and the duration of your employment.
Work experience
Please list your hobbies and recreational activities.
Hobbies and extracurriculars
Please provide the names of two references whom we may contact before awarding you this scholarship. (Name, phone number, relation)
Reference 1
Reference 2