First Name *

Last Name *

Phone *

Email *

Address *

Street Address *

City *

State *

Postal Code *

Name of Parent/Guardian *

Parent/Guardian Email *

Parent/Guardian Phone Number *

High School Name *

Anticipated Graduation Date *

Were you dual enrolled during high school? *

Yes

If Yes, where were you dual enrolled? (Only answer if you selected "Yes" above.

Type of Post secondary School

4 year College/University

Community College

Vocational/Technical School

Have you committed to any post high school education? If so, list the school(s).

Major field of study you plan to pursue

Describe your work experience over the past four years. Include Employer, Position, Dates Employed, and Hours per Week. *

List all community activities. Include Activity, Years Participated, and Awards/Honors. *

List all school activities. Include Activity, Years Participated, and Awards/Honors. *

List all academic achievements. Include Activity, Years Participated, and Awards/Honors. *

List any grants or scholarships already awarded or pending. Include Name of Award, Amount, Granted, Pending. *

If selected as a finalist, are you available for an interview (in person or by phone)? *

Yes

Upload your essay: “How will your role in your chosen career path impact your community and your future?” - Acceptable formats are DOCX/PDF. *

PDF, DOCX or DOC

What is your current GPA? *

Upload your current transcript or use the email in the Application Appraisal Form - Applicants must include a transcript, and have the appropriate school representative fill out the Applicant Appraisal Form. [Link] - Acceptable formats are DOCX/PDF.

PDF, DOCX or DOC

Upload first letter of reference. - Acceptable formats are DOCX/PDF. *

PDF, DOCX or DOC

Upload second letter of reference. - Acceptable formats are DOCX/PDF.

PDF, DOCX or DOC

Upload third letter of reference. - Acceptable formats are DOCX/PDF.

PDF, DOCX or DOC

Upload a resume (optional) - Acceptable formats are DOCX/PDF.

PDF, DOCX or DOC

Applicant Signature (Parent/Guardian must review and approve if applicant is under 18) *

Clear

I certify that the information provided in this scholarship application is true, complete, and accurate to the best of my knowledge. I understand that providing false or misleading information may result in disqualification or revocation of any scholarship award. If the applicant is under 18 years of age, the parent or legal guardian listed in this application acknowledges review of this submission and consents to the applicant’s participation in the scholarship process. The parent or legal guardian also authorizes SYCBA to contact the applicant regarding the scholarship and grants permission for SYCBA to use the applicant’s name, likeness, photograph, video, statements, school name, and scholarship-related information for promotional, publicity, and educational purposes in print, digital, social media, and other marketing materials without compensation, except where prohibited by law.

I consent to being contacted by SYCBA regarding this scholarship application and related announcements by phone, email, and text message. I also authorize SYCBA to use my name, likeness, photos, videos, statements, school name, and scholarship-related information for promotional purposes related to the scholarship program, without compensation, except where prohibited by law.