2023 Renewal Application for BVG Scholarship

All requested information MUST be furnished completely. Failure to supply any part of the requested information voids application from consideration. Applications and other required information must be submitted no later than midnight, June 2, 2023.

I. Applicant's Information

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Best Contact Phone # *

Applicant's Email *

Email

Confirm Email

Date of Birth *

Alternate Contact Information

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Home/Cell Phone *

Work Phone

Email *

Email

Confirm Email

II. Education & Training (List last or current college term)

Year? *

What Term? *

Major? *

Minor? *

GPA? *

What college or university do you plan on attending this coming year? *

III. College Activities

List them below. If you have none, enter 'None'.

Honors and Awards *

Offices held in class or college clubs, organizations, etc. *

List each, a description, and number of months/years of involvement.

Other college activities: *

List each, a description, and number of months/years of involvement.

IV. Non-school Activities

List them below. If you have none, enter 'None'.

Non-school activities *

(i.e. volunteerism, music study, church activities, sports, hobbies, etc.)

V. Supporting Information

Attach a complete transcript: *

Click or drag files to this area to upload. You can upload up to 3 files.

A complete transcript, including the spring semester, of applicant’s college work must accompany the application form. If a complete transcript is not submitted, the application will not be reviewed. NOTE: If school uses a pass/fail system, grade evaluation is required.

Include photograph of applicant. *

Click or drag a file to this area to upload.

A recent black & white photo of the applicant for publicity purposes. Must be head and shoulder at least 2” x 2 1/2”.

VI. Career Goals

Please list in twenty-five words or less your career goals. *

VII. Certification

I hereby make application for a J100 Scholarship Renewal award and submit the contained information to assist the Scholarship Committee in evaluating my candidacy and certify that:

1. All the information submitted in this application is true and correct;

2. I will use any funds received from the J100 only for the propose of paying related expenses for my college education;

3. I will notify the J100 immediately if there should be any interruption in my plans for continuing my education this coming year.

Do you understand and agree to the terms listed above? *

Yes, I understand and agree to the terms listed above.

Applicant's Signature *