ESB EDUCATION FOUNDATION, INC. 2019 Scholarship Loan / Grant Application:
Last Name *
Your answer
First Name *
Your answer
Middle Name *
Your answer
Home Address - Street No. & Name Line 1: *
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Home Address - Street No. & Name Line 2:
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Home Address - City/Town: *
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Home Address - State: *
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Home Address - Zip Code: *
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Home Phone No.: *
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Cell Phone No.: *
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Email: *
YOU MUST REGULARLY CHECK YOUR EMAIL IN CASE WE NEED ADDITIONAL INFORMATION.
Your answer
List High Schools attended and dates of attendance: *
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Provide your latest GPA. (not necessarily through the end of the academic year) *
If selected to be interviewed, final Official Transcript must be submitted.
Your answer
Provide your latest weighted GPA. (not necessarily through the end of the academic year) *
If selected to be interviewed, final Official Transcript must be submitted.
Your answer
Provide your latest Class Ranking in the following format: ___ of ______ . (not necessarily through the end of the academic year) *
If selected to be interviewed, final Official Transcript must be submitted.
Your answer
Provide your latest SAT scores for the following (labeling each): Math, Critical Reading, Writing and Vocabulary. If not taken, type NONE in the Answer. *
If selected to be interviewed, a copy of your Official Scores must be submitted.
Your answer
Provide your latest ACT scores for the following (labeling each): English, Math, Reading, Science, Composite; and Rank (State/US) %. If not taken, type NONE in the answer. *
If selected to be interviewed, a copy of your Official Scores must be submitted.
Your answer
List and briefly describe your participation in school activities: *
Your answer
List and briefly describe your participation in community activities: *
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List and briefly describe your participation in engineering related activities such as Scouts, Engineering Challenges, First Robotics, Lego League, etc.: *
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What employment experiences have you had and dates? *
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How will you supplement assistance? *
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Fathers (guardian) Name: *
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Fathers (guardian) Address: *
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Fathers (guardian) Telephone Number: *
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Fathers (guardian) Occupation: *
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Mothers (guardian) Name: *
Your answer
Mothers (guardian) Address: *
Your answer
Mothers (guardian) Telephone Number: *
Your answer
Mothers (guardian) Occupation: *
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List name, age and school level of all your siblings: *
Your answer
Briefly explain your need for financial assistance: *
[Limit 200 characters]
Your answer
List those engineering schools to which you have applied for admission, and indicate which schools have accepted you for admission. *
Your answer
Intended College/University of choice, if known at this time:
Your answer
Intended Engineering Discipline (Civil, Mechanical, Electrical, Chemical. Computer, Biomedical, etc.) *
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Enter the name of your "Engineering Career Mentor Teacher"
This is the teacher of your high school science, technology, engineering or math program that has provided instruction and activities related to your interest in a career in engineering. Naming a school counselor is also appropriate.
PLEASE PROVIDE THE FULL NAME OF THE INDIVIDUAL, SCHOOL NAME & EMAIL ADDRESS: *
Your answer
Application Submission Agreement:
By submitting this application, the applicant agrees the all the information provided is accurate and complete, and that if selected for an interview by the ESB Foundation Scholarship Committee, he/she will be available for an interview on April 28, 2019.

Notes:
Upon notification to be interviewed, the final Official Transcript and SAT/ACT Scores must be emailed to rmagnani@wbcm.com and their originals must be brought to the interview.

APPLICATIONS MUST BE COMPLETE OR THEY WILL NOT BE PROCESSED!
For questions and information email: rmagnani@wbcm.com

Application must be submitted by 11:59 pm on March, 31 2019
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