©

The Holiday Club

P.O. Box 1554
Monroeville, AL 36461
President: Sylvia Hands
Scholarship Form
2022 - 2023
Please return by: April 28, 2023
Please complete the following. The back may be used for additional information, if needed.

Full Name _____________________________________________________________________

Last First Middle

Mailing Address _______________________________________________________________

_______________________________________________________________

Phone _____________________________________________________________

Future Plans ________________________________________________________

Have you applied and/or been accepted to a college or university? Yes No If yes,
Please write the name of the college or university _________________________

Academic Awards: ___________________________________________________

___________________________________________________________________

School Activities: ____________________________________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Community Activities: ________________________________________________
___________________________________________________________________
Please attach a 150 word (or less) essay describing yourself and your future plans.

Applicant’s Signature Date

To be completed and signed by School Counselor or Principal

High School GPA __________________ ACT Composite ________________
Signature __________________________________________________________
Printed Name:_______________________________________________________
Position: ___________________________________________________________
This scholarship is for the amount of: $1000.00_
Please return any of the emails or address:

sylvia.hands@yahoo.com

rgmalone@yahoo.com

ctgrace1210@gmail.com

The Holiday Club

P. O. Box 1554
Monroeville, AL 36461