Scholarship Application Page 2

List all School Sponsored Extra-Curricula/Club Activities (Activity, Position, Years Active, Accomplishments):
List all Church Sponsored Activities (Ministry, Position, Years Active, Accomplishments):
List all Community Activities (Activity, Position, Years Active, Accomplishments):
List two (2) references in the spaces provided:
First Reference (First Name, Middle Int., Last Name): *
First Name
Middle
Last Name
Current Mailing Address: *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Cell or Home Phone Number:*
Occupation (put unemployed or retired if applicable) :*
Second Reference (First Name, Middle Int., Last Name: *
First Name
Middle
Last Name
Current Mailing Address: *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Cell or Home Phone Number:*
Occupation (put unemployed or retired if applicable):*

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