*1.Contact Information(Required.)

Name

Address

City/Town

State/Province

AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming

ZIP/Postal Code

Email Address

Phone Number

*2.Employee Contact Information(Required.)

Employee Name

Employee Job Title

Employee Email

Employee Phone Number

Employee Work Location

*3.Relationship of Applicant to Employee(Required.)

ChildDependent

*4.Is the Employee Salaried or Hourly?(Required.)

HourlySalaried

*5.Which best Describes your education level?(Required.)

High School JuniorHigh School SeniorCollege FreshmanCollege SophomoreCollege JuniorCollege SeniorVocational / Technical School Student

*6.Current High School, College or Vocational School(Required.)

7.GPA

*8.Which best describes your ethnicity?(Required.)

WhiteBlack or African AmericanHispanic or LatinoAsian or Asian AmericanAmerican Indian or Alaska NativeNative Hawaiian or other Pacific IslanderOther

9.List any Extra Curricular Activities and/or Community Services you have been involved with, along with dates.

*10.Essay Question:

Describe a time when your commitment to hard work helped you achieve excellence in school, work, or your personal life. What challenges did you face, what actions did you take, and how will this experience shape your future goals?(Required.)

300 Words Minimum - 500 Words Maximum

Choose FileNo file chosen

*11.Letter of Recommendation(Required.)

Please provide a letter of recommendation from either a teach or coach, not a personal reference.

Choose FileNo file chosen

*12.Copy of Transcript(Required.)

Provide a copy of your most recent transcript.

Choose FileNo file chosen

*13.Consent(Required.)

I acknowledge that, by clicking the checkbox as my official signature, I agree to the Official Scholarship Rules.