STUDENT AND PARENT CONTACT INFORMATION

School Name:

School Address:

Student First Name

Student Last Name

Preferred Name

Gender

Date of Birth

Ethnicity

Street Address

Unit/Suite

Student Email

Student Phone

City

State

Postal Code

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone

Please select all that apply

I have received a scholarship offer from my institution or another organizationI am planning to attend a public college/ post-secondary instituteI am planning to Private college/ post-secondary instituteI am planning to live on campusI and/or my parents qualify for federal Pell grant fundingI will be attending an out of state college/ post-secondary institute

ACADEMIC BACKGROUND

I acknowledge that I'm currently a high school senior (grade 12).

Student Unweighted GPA

Post Secondary Institution:

Expected Major

Post Secondary Institution Street Address:

Unit/Suite

City

State

Postal Code

Leader's Phone

Club/Organization Activities

Please check this box if you need to list additional extracurricular activities.

Club/Organization

Club/Organization Leader

Leader's Phone

Club/Organization Activities

VOLUNTEER HISTORY

Club/Organization

Club/Organization Leader

Club/Organization

Leader's Phone

Leader's email:

Total Volunteer Hours

Volunteer Activities

Please check this box if you need to list additional volunteer activities.

Club/Organization

Club/Organization Leader

Leader's Phone

Total Volunteer Hours

Volunteer Activities

Club/Organization

Club/Organization Leader

Leader's Phone

Total Volunteer Hours

Volunteer Activities

ACKNOWLEDGEMENTS AND ATTACHMENTS

By typing my name below, I hereby certify that all information on this application is true and accurate. I am fully aware that any misrepresentation will result in disqualification of my application.

Student Full Name

Today's Date

Parent Full Name

Today's Date

Please upload a personal essay in PDF or Word doc format answering the following prompt in 500–700 words:

Dr. Martin Luther King, Jr.’s assassination took place on Thursday, April 4, 1968, in Memphis, Tennessee. Dr. King penned this quote: “Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.” Share your reaction to this quote and provide at least two ways you can fight against the spread of hate and encourage love for others in your community.

Upload Your Essay

Please upload two letters of recommendation.

Upload Signed Letter of Recommendation 1

Upload Signed Letter of Recommendation 2

Please upload a copy of your most recent transcript or report card.

Upload Your Document