(Asterisks indicate required field)
Name of Applicant (First Middle Last)
Address
City
State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip Code
Email Address
Name of Secondary or High School
Year of Graduation
Year of Birth
Member Firm
Employee of Member Firm
Mother’s Name
Father’s Name
I certify that the information in this application is complete and accurate to the best of my knowledge and belief.
Signature of Applicant
Date
I approve the submission of this application.
Signature of Parent or Guardian
Signature of High School Guidance Counselor
After application is received and acknowledged, this page will be placed in a sealed envelope and will not be opened until after selection of scholarship recipients has been made. The Committee and the Board of Directors will have no knowledge of this information during the selection process.
High School (name and address)
If you graduated before this year, briefly describe what you’ve been doing since high school:
Kindly ask your Guidance Counselor to attach a copy of your transcript to this application, as this is a requirement for applying. Be certain that the guidance counselor signs the transcript.
Name and address of school you intend to enroll in for the next academic year:
Have you been accepted?
How long is the course of study?
When do you expect to finish?
Briefly describe your planned course of study:
What are your plans for the summer?
What are your career plans after completing your education?
What course of study have you followed in high school?
Class Standing (____ of ____):
Have you taken the College Board Examinations? YesNo
If yes, please list subjects and scores:
Subject
Aptitude Score
Achievement Score
What honors, awards, prizes or distinctions have you received?
What activities in school, other than sports, have you participated in? Also please list any offices that you have held.
Describe any other group activities in the community in which you have participated and list offices held in organizations.
List and describe your hobbies and interests.
If you want to share, describe any extraordinary responsibilities you have at home.
What work experience have you had?
Submit an essay of 500 - 1000 words. You may use either of these prompts for your essay: Prompt #1: Explain how you chose your major and describe what you like about your chosen course of study. Prompt #2: Discuss a situation in depth that taught you a valuable life lesson.
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