Scholarship Application

Name

Date of Birth

Address

City

State

Zip

Phone

Parent/Guardian Name

Parent/Guardian Phone

Number of Siblings

Academic Information

High School

City & State

Cumulative GPA

Class Rank

ACT Composite

SAT Composite

High School Academic Awards

High School Extra Curricular Participation/Organizations

High School Extra Curricular Awards

Work Experience

Employer

Title

Length of Employment

Higher Education

School / College / University

Major / Program

Reason For Choosing

Occupation Plan

Please Check

I confirm that I am a graduating senior on or before June 15, 2024

I confirm that I am a US citizen and will be attending a higher educational institution in the United States beginning in 2024

Referred By

Please Type Name & Date

Lastly, in the spirit of Mike Frantz who was one of the funniest people in the world, please submit your favorite joke (please keep it PG-13 or better)

35131

Academic Information

Work Experience

Higher Education

2022 Winners

2023 Winners

Contact Info