Local Scholarship Application

COLUMBIA HIGH SCHOOL

LOCAL SCHOLARSHIP APPLICATION
Fill out all information except for the name of the scholarship, make copies, then put in the name of the scholarships.

NAME OF SCHOLARSHIP:__________________________________________________________________________

NAME:__________________________________ADDRESS:_______________________________________________

CITY:___________________________________ZIP:________________PHONE:______________________________

FATHER:________________________________OCCUPATION:___________________________________________

PLACE OF EMPLOYMENT__________________________________________________________________________

MOTHER:_______________________________OCCUPATION:____________________________________________

PLACE OF EMPLOYMENT__________________________________________________________________________

NUMBER OF DEPENDENTS_____________AGES:_______________________________________________________

INCOME RANGE OF FAMILY:

____Under $15,000 ____$15,000 - $20,000 ____$20,000 - $25,000 ____$25,000 - $30,000

____$30,000 - $35,000 ____$35,000 - $50,000 ____Over$50,000

EXPLAIN WHY YOU NEED THIS SCHOLARSHIP

_______________________________________________________________________________________________

NAME OF COLLEGE YOU ARE PLANNING TO ATTEND:__________________________________________________

MAJOR: _________________________

DO YOU PLAN TO ATTEND FULL-TIME____________ OR PART-TIME___________

DO YOU PLAN TO WORK WHILE ATTENDING COLLEGE?______________________

LIST ACADEMIC AWARDS AND HONORS:

________________________________________________________________________________________________

LIST EXTRACURRICULAR ACTIVITIES INCLUDING HOBBIES AND SPECIAL TALENTS:

________________________________________________________________________________________________

LIST JOB EXPERIENCES:

COMPANY DATES OF EMPLOYMENT DUTIES

________________________________________________________________________________________________

NOT TO BE FILLED IN BY STUDENT

CLASS RANK______ G.P.A._____________

SAT SCORES: VERBAL________ MATH_______ TOTAL____________

ACT SCORES: ENGLISH________ MATH_______READING________ SCIENCE_______COMPOSITE_______