High School Scholarship Application Form

BASIC INFORMATION
Patricia D. Wright Scholarship Application

The information provided on this form will be used by the Patricia D. Wright Foundation to select recipients for scholarships. Please complete all information including other scholarships or financial support you have. It’s important that you give complete and honest details concerning your grades, class rank, college/career plans, activities and financial information. ALL SCHOLARSHIP AWARD RECIPIENTS HAVE 1 year from the date of scholarship award to enroll in an educational institution AND provide details on the college/university/trade school they will attend. Failure to enroll in an educational institution within 1 year of award will result in any scholarship award forfeited and returned to the PDW Foundation for future scholarships.
Student's Full / Legal Name

First NameLast Name
Student ID:
Student Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student Phone Number

Area CodePhone Number
Student E-mail
Student Birth Date

MonthDayYear
Gender

Academics
Academic GPA
Class Rank
Schools to which you are applying
School 1
School 2
School 3
School 4
Will Live
Major(s) You Are Considering

In order of preference, list the major(s) you are considering (Very important for scholarship eligibility).
Major 1
Major 2
Estimated cost
School Type & Estimated Cost

REFERENCES:

Please list one educator and at least one community person who would recommend you for a scholarship. Please do not list the person who completes a scholarship recommendation for you.
Reference 1 Name (Position,Phone Number)
Reference 2 Name (Position,Phone Number)

SCHOOL / COMMUNITY ACTIVITIES / WORK / EXPERIENCE/SPORTS/AWARDS/ETC:

List name of club, etc. and years of participation. If you volunteered, list the name of organization and the number of hours, weeks and years that you volunteered. If you worked, list the company, hours per week and length of time. Attach an additional sheet or resume if necessary.
School Activities / Offices Held 1: (not sports)
School Activities / Offices Held 2: (not sports)
School Activities / Offices Held 3: (not sports)
Community Service / Volunteer Activities 1 (outside of school)
Community Service / Volunteer Activities 2 (outside of school)
Sports Participation 1
Sports Participation 2
Will you be participating in a sport(s) this year?
What Sport?
School / Community Awards and Honors 1 (no matter how small) CSF, GSE, National Honor Society, Girl/Boy Scouts, 4-H, Governor’s Scholar, etc.
School / Community Awards and Honors 2
School / Community Awards and Honors 3
EMPLOYMENT 1: List past and present work and length of time employed.
EMPLOYMENT 2: List past and present work and length of time employed.

Father/Stepfather/Guardian Name
Mother/Stepmother/Guardian Name
Number of dependents in home:
First generation to attend college?
Other income that can be used for educational purposes (inheritance, college funds, etc)-do not include home equity, IRA's or other retirement accounts (optional):

SCHOLARSHIP RECEIVED TO DATE 1
AMOUNT 1
SCHOLARSHIP RECEIVED TO DATE 2
AMOUNT 2
STUDENT STATEMENT:
Please upload a photograph which we use for identification and when recipients are announced.

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Submission Time

MonthDayYearHourMinutesAM/PM Option
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BASIC INFORMATION