Lilly Endowment Community Scholarship Application
Requirement 2: Biographical Information
Personal Information
First Name *
Legal
Your answer
Last Name *
Legal
Your answer
Middle Name
Legal
Your answer
Sex *
Required
Home Address *
Street
Your answer
Home Address *
City
Your answer
Home Address *
State, Zip
Your answer
Home Telephone Number
Your answer
Cell Phone Number
Your answer
Email Address *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
High School Currently Attending *
Your answer
How many years have you been attending this school? *
Your answer
Other Secondary Schools Attended
School Name and Address
Your answer
Dates of Attendance
From (month/year) To (month/year)
Your answer
Family Information
If any of the following requested information is not applicable to your situation, please fill in the provided blank with N/A.
Father's Information
Father's Full Name *
Your answer
Is father living? *
Required
Father's Age
Your answer
Father's Address
(If different from yours)
Your answer
Father's Occupation and Company Name *
Your answer
Father's Education Level Attained *
Required
Undergraduate College Attended *
Your answer
Degree and Date Awarded *
Your answer
Graduate School Attended *
Your answer
Degree and Date Awarded *
Your answer
Father's Email Address *
Your answer
Mother's Information
Mother's Full Name *
Your answer
Is mother living? *
Required
Mother's Age
Your answer
Mother's Address
(If different from yours)
Your answer
Mother's Occupation and Company Name *
Your answer
Mother's Education Level Attained *
Required
Undergraduate College Attended *
Your answer
Degree and Date Awarded *
Your answer
Graduate School Attended *
Your answer
Degree and Date Awarded *
Your answer
Mother's Email Address *
Your answer
Check if appropriate
If not with one or both parents, with whom do you live?
Full Name, Street Address, City
Your answer
If not your parents, who is your legal guardian?
Full Name, Street Address, City
Your answer
Ages of brothers, sisters, stepbrothers, and stepsisters currently living with you in your home, including those the family is supporting in college
Age, Grade, College(s) Attended
Your answer
Number of people currently in your household *
Your answer
Are you the first generation of family members to attend college/technical school? *
Required
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