* 1. What is your first name?

* 2. What is your last name?

* 3. What is your street address?

* 4. What is your phone number?

* 5. What high school did you graduate from?

* 6. What is your GPA?

* 7. What college do you plan to attend in the Fall 2017 (please submit a copy of your acceptance letter to the administrative office)?

* 8. What extracurricular/community service activities have you participated in during your high school years?

* 9. In 150-250 words, explain how this scholarship will help you to pursue your educational goals?

* 10. If chosen as a recipient of this scholarship...

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