Application Submission Scholarship Applying For:Bill Berrier Scholarship FundEric Scott Langdon and Diana Monzeglio Scholarship Fund for ArtistsEric Hall Scholarship FundJackie Harrigan-Haase Memorial Scholarship FundPersonal InformationName* First Name Middle Last Name Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneCell PhoneEmail Are you a military dependent?* Yes No Are you a foster youth?* Yes No Please request a letter of recommendation to accompany your application.Name of recommender Academic InformationName of High School Currently Attending Cumulative Grade Point Average (weighted / unweighted) What is your intended college major? What is your intended career? First choice of college or university for fall 2019 The school must be accredited or licensed. If accepted, please include acceptance letter.If you are waiting to be notified, to which colleges or universities have you applied?One per line. Please include your top 3-5 choices.Please list any financial aid, grant or scholarships you have already received for the 2019-2020 college academic year and other scholarships you have applied for this yearName of aid/grant/scholarshipStatus (Indicate received or applied) Extra-curricular activities, community service, work experience, awards & honorsExtra-Curricular Activities Please list any school sports or leadership experiences over the past 3 years.Community Service ActivitiesName of OrganizationDates (from/to)Average hours per monthActivities / Positions Please list any involvement with nonprofit, community, civic and/or faith-based organizations for the past 3 years only.Work Experience/InternshipsName of BusinessDates (from/to)Average hours per monthPositions / Responsibilities Please list any internships or work experience over the past 3 years.Honors & Awards Please list any honors or awards you have received in the past 3 years.Personal StatementIn the space below, please describe your personal statementEducational & Career GoalsIn the space below, please describe your educational and career goals.I have requested a letter of recommendation for my teacher? Yes No Name of Teacher FinancialHave you completed FAFSA? Yes No If so, what is your expected family contribution? Describe Your Financial NeedStudent SignatureDate MM slash DD slash YYYY Are You At Least 18 Years Old? Yes No If under Age 18, a parent or guardian’s signature is required My signature serves as permission for the Coastal Community Foundation to publish my child’s name and photos in the event he/she receives a scholarship. Furthermore, I agree to release and hold harmless the Foundation. Parent/Guardian InformationName First Name Middle Last Name PhoneEmail Parent/Guardian SignatureDate MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.
