Personal Information:
Student's Name:
___________________________________________________________________________
Home Address:
___________________________________________________________________________
Home Phone #:
_____________________________
College/Institution you plan to
attend following graduation
__________________________________________________________________________________________
Have you been accepted:
YES ______ NO ______
Cumulative GPA:
__________
Guidance Counselor's Signature:
_____________________________________________________________
I understand that any
misrepresentation of the facts on this application will be cause for
cancellation of this scholarship.
Applicant's Signature:
______________________________________________________________________
Date:
_________________________________
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