Please complete the below application to qualify for the scholarship award:

First Name (required)

SSN(required)

City (required)

Phone (required)

Last Name (required)

Street Address (required)

Zip/Postal (required)

Your Email (required)

Explain specifically (i.e. department names with phone numbers) your relation to Division 13. (required)

Please tell us your current G.P.A. and provide a phone number to your advisor’s office so that we may verify your academic standing. (required)

Will you graduate this year? (required)
YesNo

Where will you be attending school next fall? (This will be verified before any funds will be awarded) (required)

What do you plan to do after high school, and where do you see yourself in ten years? (required)

Are you a member in any clubs, extracurricular activities, volunteer programs or on any sports teams? Please List. (required)

What kinds of hobbies do you have? (required)

Do you have a job? Where? What hours do you work? (required)

In an essay less than 500 words please tell us your goals for the future, and what you want to do with your life. Please include examples of how hard work and a helping attitude will help you get there. Have these qualities helped you in your life already? (required)