APPLICANT'S NAME: |
|
LAST
FIRST
MI
|
|
APPLICANTS ADDRESS:
Parents
Email
Addrss:__________________________________________________________________
|
| STREET NUMBER AND NAME |
| CITY / STATE / ZIP CODE |
| HOME / CONTACT TELEPHONE
#: (
)
GRADE/AGE:
/ |
FIRST
TIME SAT
CURRENT
GPA:
OVERALL
GPA:
YES
/ NO |
HIGH SCHOOL ATTENDING: |
HIGH SCHOOL COUNSELOR OR MENTOR: |
STUDY AREAS OF INTEREST (IF
DECIDED):
|
|
NAME OF
PARENT/GUARDIAN:
(REQUIRED IF
UNDER AGE 18)
|
I would like to apply
for
the
I will pay for the SAT test each
time
Scholarship_____________
my child signs up to take the test_______
|
| By signing below, you
are
certifying that all of the above information is accurate and
true. I also permit BCWB to list my child's name in any
award recognition advertisement, picture or information publicizing the
effort of this program. BCWB will in no way use this information
for anything other than the intended purpose of accepting your child
into our scholarship program. |
APPLICANT'S
SIGNATURE
Date_________________
|
| PRINTED NAME: |
PARENT/GUARDIAN
SIGNATURE:
Date_________________
|
| PRINTED NAME: |