Student ID #_______

Santiago High School Local Scholarship

2012-13 LOCAL SCHOLARSHIP APPLICATION
Print or Type
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Last Name
First Name
_____________________________________________________________________________________
Address
City, State, Zip
_____________________________________________________________________________________
Home Telephone #
Students Cell Phone #
Students Email
_____________________________________________________________________________________
Name of Father/Guardian
Name of Mother/Guardian
_____________________________________________________________________________________
Fathers/Guardian Occupation & Employer
_____________________________________________________________________________________
Mothers/Guardian Occupation & Employer
Parents gross yearly income _________________ (Adjusted Gross Income from most recent tax return)
# of family members living in household ___________
# of family members attending college in your household ______________
Are you presently employed?
yes
no If yes, complete the following:
_____________________________________________________________________________________
Business or Company
Position
Hrs. per week
List volunteer/community service that you have been involved in during high school:
Organization
# Hrs.
Dates
Name of Person in Charge
_________________ _________
__________
__________________________________
_________________ _________
__________
__________________________________
_________________ _________
__________
__________________________________
_________________ _________
__________
__________________________________
_________________ _________
__________
__________________________________
List your extra-curricular activities (Athletics, Clubs/Organizations and school years involved):
Activities: School year/years of involvement
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Honors & awards received during high school (include the grade level that it was received.):
________________________________________________________________________________
________________________________________________________________________________

Student ID #_______
________________________________________________________________________________
________________________________________________________________________________
Leadership Positions/Year served:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Colleges you have applied to (in order of preference):
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Anticipated College Major___________________________________________________________
Career Goal ______________________________________________________________________
I verify that the information provided on this application is complete and honest and I am completing
this scholarship application on my own. Parents, your signature assures that the income stated above is
true and accurate.
__________________________________________________
Student Signature

__________________________
Date

__________________________________________________
Parent Signature

__________________________
Date

Deadline to submit this application to Upper Student Services: February 8, 2013 @3pm.