Are You Either a US Citizen Or an Eligible Non-Citizen? Yesno

PersonalInformation

LastNameFirstNameMiddleInitial

CurrentMailingAddressApt #

CityStateZipCode

SocialSecurityNumberPhoneNumber

EmailAddress

DateofBirth:MonthDayYear

Are you either a US citizen or an eligible non-citizen? YesNo

Please checkone:

□I am a 2017 graduatingseniorACT/SAT Score

□I am a 2012-2016graduate

List which colleges, universities, community colleges, or technical schools you have applied to orattend.

□I am a currently enrolled in a college, university, or technical school

Listschool:

□Total hours of Dual Credit Courses completed while in High School

Attach Transcript from Dual Credit Courses if not listed on current transcript.

SchoolActivities

List all school activities in which you have participated. Indicate years of involvement, offices held, and leadershiproles.

List any awards or honors you may have received while in high school orcollege.

Community ServiceActivities

List any community service activities (Scouts, hospital volunteer, Special Olympics, etc.) in which you have participated. List number of years and total number ofhours served.

ActivityApproximateDatesofService TotalHoursServed

Student’s Financial Information

HaveyouqualifiedforGRANTSor financing thrustudentloans?Yes No

Have you been granted any other financial aid or scholarships? Yes No

If so, from where and how much?

List any jobs or ways you earned money while in high school or college.

UnusualCircumstances

List any unusual circumstances that would affect your ability to achieve in schoolor participate in school activities and/or community service activities or that would affect your family's financialsituation.

Essay

Choose one of your community service activities. Tell why you chose this activity, what impact the experience had on you, what you contributed to the activity, andhow it has influenced your educational goals and career objectives. If you were unable to perform community service, use your essay to explain. Limit your essay to no more than 300 words. Attach to theapplication.

Recommendation

Please attach two (2) current signed letters of recommendation on schoolletterhead from a principal, an assistant principal, counselor, professor, academic advisor or teacher familiar with your qualifications for this scholarship and recommending you to be a recipient of this scholarship. Please do not use formletters.

Applicant’sStatement

I do herby certify that the information provided on this applicationis factual and correct to the best of my knowledge and myability.

Applicant’sSignatureDate

ApplicationChecklist

The application is complete, signed, and dated bystudent.

Spelling and grammar should be checked. They AREimportant.

Student Aid Form (SAR) or Texas Application for Student Aid(TAFSA)isattached.

Official High School Transcript isattached.

Official College Transcript isattached, if applicable.

Essay isattached.

Two current reference letters areattached.

Student's statement is signed anddated.