Name (Last, First, Middle) - WordPress.com

Mar 29, 2017 - 3. Phone: ... School Extra-Curricular Activities and Sports: Activity. Position/Office. 9 10 11 12. (List additional activities and sports on page 4). 6.
201KB Sizes 3 Downloads 201 Views
Harvard Woman’s Club Scholarship

2017 Application Form 1. Name (Last, First, Middle): ________________________________________________________ 2. Home Address (Street, Town, State, ZIP): ______________________________________________ 3. Phone: ____________________ E-Mail address: _________________________________ 4. Date of Birth (Month, Day, Year): _______________________ 5. School Extra-Curricular Activities and Sports: Activity

Position/Office

9

10

11

12

(List additional activities and sports on page 4)

6. List of All Honors, Awards Received in past four years Honor, Award

Indicate type:

(Scholastic, Sports, Extra-Curricular, Civic, Work)

(List additional honors and awards on page 4)

Harvard Woman’s Club - PO Box 438, Harvard, Massachusetts 01451-0438 harvardwomansclub.wordpress.com/contact-us

Year

Applicant Name: ________________________________________ 7. List all Activities:

Page 2

(Church, Scouting, Civic organizations, employment)

Activity

Position

9

10

11

12

(List additional activities on page 4)

8. Name of Accepting College/University: __________________________________________ THIS SECTION TO BE COMPLETED BY YOUR HIGH SCHOOL School Name: ___________________________________________________________________________ School Street Address: ___________________________________________________________________ City: State: Zip Code:_______________________________________________________________ GPA on a scale of: ___________________ Graduation Date: ___________________________ Guidance Counselor’s Signature: _____________________________________________________ Printed Guidance Counselor Name: ___________________________________________________ Guidance Counselor Office Telephone Number: __________________________________________ Guidance Counselor E-Mail: __________________________________________________________

I hereby certify that the information provided in this application is accurate. ______________________________________________ _________________ Signature of applicant Date ______________________________________________ _________________ Signature of parent or guardian Date (If applicant is under age of 18)

Harvard Woman’s Club - PO Box 438, Harvard, Massachusetts 01451-0438 harvardwomansclub.wordpress.com/contact-us

Applicant Name: ________________________________________

Page 3

REMINDER: Please attach the following required documents: 1. Letter of Recommendation (from Principal, Guidance Counselor, Coach or Teacher)

2. One essay – you may use one submitted with college application 3. Short biography of applicant, including career goals

Harvard Woman’s Club - PO Box 438, Harvard, Massachusetts 01451-0438 harvardwomansclub.wordpress.com/contact-us

Applicant Name: ________________________________________

Harvard Woman’s Club - PO Box 438, Harvard, Massachusetts 01451-0438 harvardwomansclub.wordpress.com/contact-us

Page 4