2019 SCHOLARSHIP APPLICATION CONFIDENTIAL
Personal Information (Please print or type)

Full Name: ______________________________________________________________

____________ Male ________ Female _________ Date of Birth ________________________________

Address: ______________________________________________________________

______________ Street City State Zip

Phone: __________________________________ E-Mail: ___________________________________

I am a legal citizen of the United States of America? Yes_____ No ______

Name of Parent(s) or Guardian: _________________________________________________________

Address of Parent(s) or Guardian if different from yours: ___________________________________ ______________________________________________________________

Father’s occupation: ______________________

Mother’s occupation: ________________________

Are you or your family involved in The Carmine Chamber of Commerce? Yes____ No _____

If so, what activities have been done in the name of the Carmine Chamber by either you or a family member? _______________________________________________________________________________________________

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CONFIDENTIAL (page 2)
2019 SCHOLARSHIP APPLICATION

Current High School:________________________________________________________ ___

Expected Date of Graduation: ___________________________________________________

Class Rank: __________ of _____________
Cumulative GPA: _______________

Is GPA unweighted or weighted? _____________________


College, University, or other Educational Entity you will attend next year? ______________________________________________________________ ________________

Location of living quarters while advancing your education? _______________________________________________

If undecided, list your top 3 educational entity choices. ___________________________________________________

_____________________________________________________________________________________________________

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Major: ______________________________________________________________ ______________

SAT: Best Score: ______________ ________________ ________________

Math Critical Reading Writing

ACT: (Comp) Score: ______________