Scholarship Application

Scholarship Application

First Name*

Last Name*

Street Address*

City*

State*

Select

Zip Code*

Date of Birth*

Email Address*

Phone Number*

Phone

Parent/Guardian Information

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian Mailing Address*

City*

State*

Select

Zip*

Parent/Guardian Email*

Parent/Guardian Phone Number*

Phone

Moon Lake Electric Account Number*

School Information

High School*

If your high school is not listed, please contact Chelsea Wilkerson 435-722-5472

Select

Principal's Name*

Guidance Counselor Name*

Guidance Counselor Contact Number*

Phone

ACT Score*

GPA*

Sources of Educational Funding

Please provide estimates regarding how much assistance you will receive from each source

Parents or Personal Savings*

If none, please enter a zero.

Scholarships*

If none, please enter a zero.

Grants*

If none, please enter a zero.

Loans*

If none, please enter a zero.

Other Sources*

If none, please enter a zero.

Biographical Information

Which scholarships are you interested in?*

Select or enter value

Tell Us About Yourself*

Please tell us briefly about your life, including your interests and hobbies.

Community Involvement*

List any community involvement, including school or local clubs.

Career Goals*

Please outline your career goals, and plans to achieve them.

Why You?*

Please tell us why you are the best candidate for this assistance.

File Uploads

Please upload the following supporting documentation:

Transcript Showing ACT Score
3 Letters of Recommendation
A Passport Style Photograph

File Uploads

Please upload the following supporting documentation:

Transcript Showing ACT Score
3 Letters of Recommendation
A Passport Style Photograph
1 page, single spaced essay on the specified topic.

File Upload*

Drag and drop files here or

Send me a copy of my responses

Privacy Notice|Report Abuse