First Name

Last Name

Mailing Address

City

State of Residence

Zip code

Phone Number

 )  - 

Your Gender

E-Mail Address


Student Status

High School Grad Year

GPA, If Known

Your Birthday

General Educational Goals
Please select the area that best matches your goal for getting your degree.

Colleges
Please select the college you attend or up to 4 colleges you are interested in attending.





Personal Statement

Please answer ONE of the following questions in 250 words or less.

(1) What are your educational goals? -OR- (2) How will winning this scholarship help you attain your goals? -OR- (3) Write about a time when "hard work" paid off.

Your personal statement will be judged on its content not your writing style. Please focus on the substance of your answer. And remember the words of Thomas Jefferson who said, "The most valuable of all talents is that of never using two words when one will do." Good luck!




Certification: I certify that the information provided on this application is complete and correct to the best of my knowledge. I further certify that if I am chosen as a scholarship recipient, I will use the funds only for expenses related to my education in an institution of higher learning in the United States.