First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Email Address

Cumulative High School GPA

Vocational Goal

High School Attended

Intended College

Major

What other scholarships have you received?

What is the profession you wish to pursue and why?

When you are finished with college, how likely are you to eventually live and work in the Elgin area

Likely Not Likely Not sure at this time

List you activities in the community and/or workplace. For example, school clubs

Please upload a letter of recommendation

Please upload a copy of your high school transcript

Please upload a head and shoulders photograph of yourself.

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