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* 1. First Name

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* 2. Last Name

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* 3. Mailing Address

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* 4. City, State

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* 5. Email Address

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* 6. Phone#

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* 7. Date of Birth

Date

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* 8. Gender

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* 9. Ethnicity

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* 10. Select High School

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* 11. Cumulative GPA

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* 12. Weighted GPA

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* 13. ACT Score

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* 14. SAT Score

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* 15. Selected College/University (where you will attend)

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* 16. College/University Location

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* 17. Major/Minor

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* 18. Total Amount of Scholarships Received ($)

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* 19. Number of Family Members in Household

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* 20. Approximate Household Income ($)

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* 21. Parent(s)/Guardian(s) Name

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* 22. Parent(s)/Guardian(s) Email

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* 23. Parent(s)/Guardian(s) Phone #

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* 24. ACTIVITIES, INVOLVEMENT, & RECOGNITION

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* 25. Why should you be awarded this scholarship (200 words or less)

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