HARRISON COUNTY STUDENT ACHIEVEMENT SCHOLARSHIP APPLICATION
Completely fill in form and then print. 

1.  Name:                                                           Last                                      First                                     Middle

2.  Home Address:
                                  Street                                                    City

    
             Telephone #                                         E-Mail Address

3.      M     F      
     Social Security No.                                                   Date of Birth

4.  Father's or Guardian's name:

   
                          Occupation                                                  Employer

5.  Mother's or Guardian's name:

    
                           Occupation                                                 Employer

6. Name of High School:
    Grade Point Average:
    Total ACT Scores:    English    Math    Reading
    Science Reasoning: Composite Score:
    Dates tested:
    SAT Scores: Verbal Math
    Dates tested:

7. Please list any course work taken in the following areas during high school:

    Honors course work:
   
    Advanced Placement (AP) course work:
   
    College Classes:
   
 
 
 


 
 

8.  List membership and  participation in school organizations and activities 
     including positions of leadership held, if any. Please do not abbreviate club and 
     organizational names. (If extra space is needed, please use another sheet and 
     attach.)
    
 

9.  List membership and participation in community, civic and religious
     organizations and activities including positions of leadership held, if any.  Do not
     abbreviate names. (If extra space is needed, please use another sheet and attach. ) 
    
 

10. List school or civil honors, awards or recognition. (If extra space is 
      =needed, please use another sheet and attach.)
    
     

11. College or Technical School Preferences: Have you      Have you             Intended
                                                                             applied?       been accepted?:  Major?

1st. Preference:         
2nd. Preference:         
3rd. Preference:         

 

 

 

 

12. What do you want to do with your life that will not only make you successful
      but will also be beneficial to your community?  (If more space is needesd , please
     use another sheet and attach.)
   

13.  Work Experience:

              Employer                 Phone                   Position                         Employed
                                                                                                                From         To
    

    

    

    

14.  Please describe in a brief paragraph why you feel you should be the recipient of this scholarship.   Include any unusual family circumstances. (If more space is needed, please use another sheet and attach.)
     

15. Attachments:
        (1) Two letters of recommendation
        (2) Transcript
        (3) Copies of ACT and SAT Test Scores
 

16. Scholarship Preference--YOU MUIST SELECT THE CATEGORY FOR WHICH 
YOU WISH TO BE CONSIDERED:
                        Academic                          Arts                       Technical
 

I certify that the information I have provided in this application is complete and 
accurate to the best of my knowledge.

_________________________________________        ________________________
                  Signature of Applicant                                                     Date