Scholarship Appl

PARRISH-HAZLEHURST

60’s and 70’s CLASS REUNION

BOOK SCHOLARSHIP FORM

Year 2012

APPLICANT INFORMATION please print clearly or type.

Applicant’s Name: ______________________________________________________________________

Last name First name Middle Initial

Home Address: ________________________________________________________________________

Street (no P.O. boxes) City State Zip

___Male ___Female Date of Birth _______________

Applicant’s phone: ________________________

Name of parents/guardians: _______________________________________________

School name: ________________________________________________________

Graduating grade point average (2.5 or above) ______________ (GPA must be verified in writing by high school counselor or final school report card.)

__________________________________ _______________________

Counselor Date

ELIGIBILITY INFORMATION

Must be graduating senior from Hazlehurst High School.
Must have a GPA of 2.5 or above to apply.
Must have completed community service hours.
List organization(s) or youth activity during the current school year.

INFORMATION please print clearly or type.

List high school, church and community activities and organization(s) in which you participated: _____________________________________________________________________________

_____________________________________________________________________________

List community services projects and hours that you have performed at church, school or in the community. Hours must be verified with the signature of a church or school officers/teacher. MUST HAVE 20 OR MORE COMMUNITY SERVICE HOURS.

______________________________________________________________________________

What are your educational and career plans?

______________________________________________________________________________

Applicant signature ________________________ Date ______________________

Parent/Guardian Signature ____________________ Date_______________________

Received by _____________________________ Date_______________________

Applications must be POSTMARKED by August 15, 2012. No Exceptions.

Applicant must attend a two or four year accredited college or university.

Mail to: 60’s and 70’s Class Reunion, P.O. Box 66, Hazlehurst, MS 39083