2012 SCHOLARSHIP APPLICATION
STUDENT APPLICANT FORM
Name___________________________________________________________________
Address_________________________________________________________________
Phone Number_________________
Date and Place of Birth_____________________________________________________
Social Security Number____________________(Optional)
Schooling Attending Now___________________________________________________
Extracurricular Activities___________________________________________________
(Sports, Clubs, Music, Drama etc.) Attach to this Form
Community Service_______________________________________________________
Class or School Honors. List ________________________________________________
(Attach to this Form)
GPA Score_______________
College or Vocational Training Program to Attend_______________________________
Your Major ______________________________________________________________
Five Hundred Word Essay: Pick your own subject to write about.
.
Veteran or Student Signature ________________________ Date ____________
Parent Signature __________________________ Date ____________
MAIL APPLICATION TO:
P.O.
SANTA ROSA, CA. 95402-1583