2016-2017 STUDENT SCHOLARSHIP INFORMATION FORM
PLEASE LIST ALL SCHOLARSHIP OFFERS (not just the ones you have accepted)

First Name: __________________________________      Last Name: ___________________________________________
Parent’s Name: ______________________________________________________________________________________
Gender (circle one) Male, Female   Race (circle one) African–American, Hispanic, Asian, Multi-Racial, Native American, White
College/University Attending: _____________________________    Location: _____________________________________
Planned Major: _______________________________________________________________________________________
Name of Scholarship/Type	*Type	School / Organization giving scholarship	Amount	(Circle One)	Accepted	
				One time	Renew	Y	N	
				One time	Renew	Y	N	
				One time	Renew	Y	N	
				One time	Renew	Y	N	
				One time	Renew	Y	N	
*Scholarship Type: Academic, Athletic, Band, Business, Church, Community, Fine Arts, Military, etc.
For Additional Scholarships: Please use another form to list additional scholarships that you were offered. We will try to announce all scholarships/awards but they may be listed on the program only.
NOTE: YOU MUST ATTACH A COPY OF THE SCHOLARSHIP AWARDS LETTER/NOTIFICATION IN ORDER
 FOR THE AWARD TO BE RECOGNIZED.
NOTE: Return this form AND awards letter(s) to Mrs. Tollison in Guidance by Friday, May 5th to guarantee printing in the program.
*** PLEASE WRITE LEGIBLY ***