RCPHS Scholarship Application
Special Note: ALL Applicants must be graduating Seniors with at least one parent of Hispanic Descent!
Last Name: *
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First Name & Initial: *
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Address1: *
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Address2:
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City/Town: *
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State: *
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Zip Code: *
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Home Phone: *
(If none, enter "None")
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Cell Phone:
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Age: *
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Date of Birth: *
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Place of Birth: *
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Email: *
(If none, enter "None")
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Mother's Maiden Name: *
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Mother's Occupation: *
(If none, Enter "None")
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Father's Name: *
Your answer
Father's Occupation: *
(If retired, enter "Retired")
Your answer
Hobbies: *
Your answer
EDUCATIONAL INFORMATION -
School Name: *
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School Average: *
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School Course of Study: *
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Extra Curricular Activities: *
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College You Will Be Attending: *
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Professional or Career Goals: *
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IMPORTANT: Our scholarship grant will be issued once we receive notification that he/she has been accepted and registered to attend a school. It is the responsibility of the applicant to notify the R.C.P.H.S. Scholarship Fund Committee of their acceptance by September 15. The award will not be forwarded until the applicant's acceptance to an institution has been confirmed. (Scholarship winner must attend the Scholarship Award Night Dinner.)
Date: *
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Electronic Signatures -
(Fill in names below as Electronic Signatures.)
Signature of Applicant: *
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Signature of Parent/Guardian: *
Your answer
POLICE HISPANIC SOCIETY USE ONLY -
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