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Culture Class Scholarshij lication Name: Last First Middle Address: ZIP: Telephone: (include area code) Email: Date of birth :. Name of Father or Guardian: Occupation: Name of Mother or Guardian: Occupation: Address of parent/guardian: Number of siblings: Ages: Number of siblings expected to be in college next fall: Name of high schools you have attended: Approximate number in graduating class: Your approximate class rank: List & describe the extracurricular school activities in which you have participated (in order of importance to you): feo Describe your community activities and interests (ex. scouting, church, work, etc.): Indicate honors and awards that you have received: Describe your work experience: Type of work Name & address of employer Dates What college or university do you plan to attend? What field of study? Are you aware of being awarded any other scholarships? If yes, describe and list the amount: Discuss in your own handwriting, “Why I want to go to college and what I hope to realize from my college experience.” Parents’ income: Please check your parents’ approximate taxable income for last year. $24,999 or below $40,000 - $59,999 —______ $25,000 - $39,999 $60,000 - $79,999 over $80,000 Number of dependent children in household: