Jackson-Madison County Sports Hall of Fame: Scholarship Application
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Please fill out this form to be considered for a scholarship awarded by the Jackson-Madison County Sports Hall of Fame organization. Selected students will be honored at the annual Hall of Fame Banquet. The information in this form will also be used to write the student's short biography for the banquet program. If you face any issues when filling out this form, please contact Victoria Blaylock by email at victoriamblaylock@gmail.com.

*Note: All information is confidential and viewed by selection committee members only.
Student Athlete Contact Information
Student Name (First, Last) *
Student Email Address
Student Phone # *
Student Home Address (Street, City, State, Zip) *
Parent(s) or Guardian(s) Name and Address *
High School *
Guidance Counselor Contact Information
Guidance Counselor Name (First, Last) *
Guidance Counselor Email Address *
Guidance Counselor Phone Number *
Student Athlete Athletic & Academic Information
Sport or Related Athletic Activity (inclusive of trainer/manager): *
Name and Address of College or University to be Enrolled in the Fall: *
GPA: *
Other Scholarships Received by Applicant: *
Major Accomplishments and Awards: *
Important Career Stats: *
Academic Accomplishments:
Other Information:
Digital Photo
Please email a digital head shot photo of the student to Victoria Blaylock (victoriamblaylock@gmail.com). In the subject line, please include the student's name and school (ex: Jane Doe - North Side High School).
Please type your name and date certifying that all information in this application is factually true and honestly submitted.
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