Scholarships

Name

First Name

Last Name

Email Address

General email address that will be used after High School

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

SCHOOL INFORMATION

GPA

Number of Students in class

Rank in Class

List in chronological order all schools attended in the last four years, including any summer or special courses.

List any academic distinction or honors you have earned and the grade levels in which you earned them (9, 10, 11, 12)

ACTIVITIES

Note activities in which you have been actively engaged (organizations, sports, or clubs) and which you feel have been most meaningful to you (include years of participation, grade, levels, and any offices held).

WORK EXPERIENCE

List employment you have held in the past three or four years.

Include position and hours per week

HIGHER EDUCATION, PUBLIC SERVICE AND MILITARY INFORMATION

If applicable, the College or University you have been accepted to

What field of study?

If applicable, the Branch of the Armed Forces you have been accepted to

Anticipated enrollment, or enlistment date

Have you been awarded (or reasonably expect to receive) other grants or scholarships?

Yes

If yes, please list the name of the scholarship and the amount you will receive

FAMILY INFORMATION

Parents: (Check if living)

Mother

Father

Stepmother

Stepfather

Legal guardian

Number of Children in Family

If you have siblings, number who will be in college

ESSAY

In a short essay, share why you believe you are deserving of a scholarship and how will you use your talents to make a difference in your community or this world. The essay must be typed and NO MORE THAN 500 WORDS.

DUE DATE

Please submit by March 30th unless stated differently guidance office

SIGNATURE

I certify that all the above information is true to the best of my knowledge.

Date

YYYY

The Brian LaViolette Scholarship Foundation is proud to have received the highest possible rating on Charity Navigator.

This four-star rating designates Brian’s Foundation as an official “Give with Confidence” charity, indicating that our organization is using its donations effectively based on Charity Navigator’s criteria.

(Old) Scholarship of Honor Application

Scholarships