* FULL NAME:

  AGE :         SEX :

 * TELEPHONE:

 * EMAIL:

 * ADDRESS:

  FATHER’S OCCUPATION:

  MOTHER’S OCCUPATION:

  NAME OF HIGH SCHOOL:

  SAT SCORE :         ACT :

  NUMBER IN YOUR CLASS:         RANK IN YOUR CLASS:         YOUR GPA:

LIST ALL EXTRA CURRICULAR ACTIVITIES IN WHICH YOU PARTICIPATE:

LIST ALL OFFICES HELD IN SCHOOL, YOUR CHURCH OR COMMUNITY:

LIST ALL COMMUNITY AND VOLUNTEER ACTIVITIES YOU HAVE PARTICIPATED IN:

HAVE YOU EVER HELD A JOB TO EARN MONEY OR EXPERIENCE? IF YES, WHAT DID YOU DO?

  WHAT COLLEGE DO YOU PLAN TO ATTEND?

  HIGH SCHOOL COUNSELOR:

  DATE:

NOTE: PLEASE SUBMIT THE FOLLOWING ITEMS WITH THE APPLICATION FORM:

• SEALED OFFICIAL HIGH SCHOOL TRANSCRIPT (Guidance Counselor can email)
• 3 CHARACTER REFERENCES
• TYPE ESSAY STATING “WHY I DESIRE THIS SCHOLARSHIP”
• NAME OF THE STUDENT MUST BE ON THE ESSAY AND CARRY THE STUDENT’S SIGNATURE

HIT SUBMIT BUTTON AT THE BOTTOM...OR MAIL PACKET TO:
SCHOLARSHIP COMMITTEE, CRITERION CIVIC CLUB, P.O. BOX 1181, EUSTIS, FL 32727

QUESTIONS? EMAIL: Scholarships@CriterionCivicClub.org

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