Please type your information below and then print the completed form, OR you may print and then complete in BLACK ink only. When done, return this completed form and any additional requested information to your school's guidance office no later than April 8, 2011. DO NOT forget that you and your parent/guardian must sign this application for consideration of scholarship funds.

Personal Information

Last Name: First Name:
Age:
Address: City:
State: (Abbreviation) Zip:
Phone Number :(include dashes)

Parent/Guardian Information

Mother's Name:
Mother's Occupation:
Mother's Address: (if different from above)

Father's Name:
Father's Occupation:
Father's Address: (if different from above)

Student Test Scores

High School GPA: (4.0 Scale) High School Class Rank: (Rank/Total)
ACT Composite Score: SAT (Verbal): SAT (Math):

Courses Taken

List all courses taken AND the grade you earned during your 11th GRADE YEAR, 1ST SEMESTER.

List all courses taken AND the grade you earned during your 11th GRADE YEAR, 2ND SEMESTER.

List all courses taken AND the grade you earned during your 12th GRADE YEAR, 1ST SEMESTER.

Character

A: Submit on a separate sheet of paper a list of your extra-curricular activities, evidence of leadership ability, and honors received.

B: Submit a one-page essay describing your career plans and why you should be selected to receive an academic scholarship.

Financial Information (Parent/Guardian(s))

This section is to be completed by the parents or guardians of the student applying for a scholarship sponsored by the Wakulla Academic Boosters.

1. What is the total number of exemptions claimed on your IRS Form 1040 or 1040A?
2. How many family members are attending college?
3. What was your total income last calendar year? For Example: $15,000.
4. Do you currently have or expect to have any unusual expenses? If so, please comment in the space below.
Records Release and Signature

This information is true to the best of my knowledge.

Parent Signature _________________________________________________ Date_______________________

If I am awarded a scholarship, I hereby give my permission to Wakulla High School to release my address, phone number, social security number and my parent/guardian's address to the Wakulla County Academic Booster Association representative in charge of distribution of scholarship monies.

Student Name (printed)____________________________________________

Student Signature ________________________________________________ Date _____________________

Please review your application above. Check for any errors or omissions. Use your browser's print option, and submit this application along with the materials requested in the "Character" section to your school's Guidance Office, no later than April 8, 2011. Remember, both the student and parent/guardian must sign this application for scholarship consideration. Thank you for your submission. Good Luck!

Click here to return to the WHS Scholarship page.