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Scholarship Registration

(*) Mark are required
First Name *
Last Name *
M.I
Gender Pronouns *
Home Address: Street Number and Name *
City *
County *
State *
Zip Code *
Phone *
Email *
Race/Ethnicity/Nationality *
Additional Ethnicity Heritage you want to Honor
Household Members *
Total Household Income *

High School (Currently Attending or Graduated) *
Grade Level *
College (Currently Attending or Your Target School) *
Grade Level (2nd) *

Applicants will submit

A resume (include high school / college name, major and GPA)

A proposal to address a local community need (At least ONE of the following can be submitted: a maximum of two-page, double-spaced essay; a maximum of 3 minute video; 3 minute audio file or other digital files are possible)

OR

An essay related to their personal experiences of diversity and/or volunteerism in their community (At least ONE of the following can be submitted: a maximum of two-page, double-spaced essay; a maximum of 3 minute video; 3 minute audio file or other digital files are possible)

Special consideration for applicants with Financial need will be prioritized.

How did you hear about the scholarship program? *
Resume *
Proposal or Personal Statement *
Additional Message
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