Rose Bud Local Scholarships Form
First and Last Name *
Please check mark each scholarship you are applying for: *
Social Security Number *
Address P.O. Box/Street Name *
Address City
Address Zip Code
Father/Guardian First and Last Name *
Father/Guardian Occupation *
Mother/Guardian First and Last Name *
Mother/Guardian Occupation
Major in College *
ACT Score in English *
ACT Score in Math *
ACT Score in Reading
ACT Score in Science *
ACT Score Composite *
Accuplacer Composite
G.P.A. *
List any Academic Honors *
List other Honors *
Describe your future plans *
What course of study do you wish to pursue in college? *
List your first choice of college: *
List your second choice of college or N/A: *
Why did you select these particular colleges? *
List any extracurricular activities you are involved in (include school, community, church, etc) *
Is your family able to contribute to provide any financial assistance towards your post-secondary education? *
What financial arrangements have you personally made to aid you in your post-secondary efforts? *
Give a statement regarding your high school performance, be sure to include at least one sentence about each area: School Citizenship, School Attendance, Academic Accomplishment towards post-secondary education. *
List any scholarship you have received to date, giving length, and approximate financial amount. *
If awarded this scholarship, would you be willing to serve as a spokesman for this organization? If yes, please list or describe the ways in which you would be willing to help promote the Rose Bud Scholarship Funds. *
I authorize the release of my GPA, rank in class, ACT scores, and other information that may be required of the Rose Bud Scholarship Committee in determining my eligibility for any scholarships that I am applying for. Please type your full legal name as your electronic signature. *
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