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* 1. Name (First, Middle, and Last)

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* 2. Name you prefer to be called (if different from first name)

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* 3. Date of Birth

Date

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* 4. School Name (Please write out the entire name, not just initials)

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* 5. GPA

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* 6. In order to certify income eligibility, please confirm the following:

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* 7. Please list any extra-curricular activities you are involved in and describe your roles.

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* 8. Please upload a recommendation letter from a guidance counselor or teacher.

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* 9. Please upload an original essay (minimum 1000 words) describing the facets of what you believe makes life better for those in your community and how you commit yourself to achieving that goal.

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* 10. Contact email and/or phone number: (in case we need to get in touch with you for a missing piece of your application, or to deliver a certificate and check due to Covid or other changes, etc....this will only be used if we cannot reach you through the school)

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