$250 Scholarship Application Form (Deadline to submit March 31, 2022)

$250 Scholarship Application Form (Deadline to submit March 31, 2022)

Please type or print your answers.  If application is illegible, it will be returned to you.

Last Name: _____________________________________ First Name: __________________________________

Mailing Address:

Street: _____________________________________________________________________________________

 

City: __________________________________ State: ____________________ ZIP: _______________________

Daytime Telephone Number: (    )_______________________________________________________________

Date of Birth:          Month:                                                    Day:                                                         Year: _________

Current High School: _____________________________________________Number of years attended: _______

I will be attending the following College/Technical School in the Fall of 2022:

___________________________________________________________________________________________

I will be entering the above-mentioned College/Technical School as a: (Circle one)

Freshman                               Sophomore                              Junior                      Senior

__________________________________________________________________________________________

 

 

Name and address of parent(s) or legal guardian(s): Use reverse side of application form if you need more space.

Name(s)

__________________________________________________________________________________________

Street: _____________________________________________________________________________________

City: __________________________________ State: ____________________ ZIP: _______________________

Family: Brothers_____________________________________________________________________________

Sisters_______________________________________________________________________________

Other family members residing in the home_______________________________________________________

*Applicant is required to submit a short essay 200 words or less about what does the Chamber of Commerce mean to you. Answer the following questions on the reverse side of the application or add a page with your essay. Anyone who provides false or misleading information will have their application removed. **A screening committee consisting of Chamber members will review all submissions. ***Submit all information to your Senior Guidance Counselor, FBLA Leader, or Chamber of Commerce, 28 Welcome Center Drive, Albany, KY 42602.

  1. How will this scholarship help you?
  2. How have you contributed to your community?
  3. What are your academic goals and/or career goals?
  4. Why do you deserve this scholarship?
  5. Tell us about yourself?
  6. Tell us about a time you failed and what you learned from it?

 

 

 

__________________________________________________________________________________________

Signature/Date