1. Student - Last Name:* First Name:* MI: Date:*
2. Address:* Apartment/Unit #:
3. City:* State:* Zip:*
4. Grade Level:*
5. Desired Scholarship (if known):
6. Gender:M F Religion:
7. Church/Parish:

1. Mother's Name: Employer:
2. Home Phone: Cell:
3. Work Phone: Email:
4. Father's Name: Employer:
5. Home Phone: Cell:
6. Work Phone: Email:

Please check all that apply. Also, please indicate years of participation and any positions held.

1. Cheerleading
2. Class Officer/Student Government
3. Band
4. Choir
5. Track
6. Baseball
7. Softball
8. Volleyball
9. Soccer
10. Basketball
11. Football
12. Other

Please attach a letter or statement explaining your request for financial need. Please remember to also include the amount you are requesting. If applicable, please attach a letter from Pastor.

I hereby certify that all information provided in this application is true and accurate.

Your signature below authorizes a release of all records that may be requested by the Scholarship Committee. The use of the released information will be used exclusively for the determination of eligibility.

1. Signature:* Date:*