Due date: Monday, February 1, 2021 Personal InformationName* First Name Middle Last Name Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell PhoneEmail Career InformationName of College Currently AttendingCumulative Grade Point AverageWhat is your declared college major?What is your intended career?Work ExperienceWork ExperienceName of BusinessDates (from/to)Average hours per monthPositions / Responsibilties Please list any work experience over the past 3 years.Research, internships, awards & honorsResearch or internshipsName of Organization or DepartmentDates (from/to)Average hours per monthActivities / Positions / Areas of Study Please list any relevant experiences within the last 3 years.Honors and Award Achievements Please list any honors or awards you have received in the past 3 years.Personal StatementEducational & Career GoalsIn the space below, please describe your educational experience and career goals. (500 word maximum) Statement of Financial NeedStatement of Financial NeedIn the space below, please describe your financial need and how this scholarship would help you meet academic goals. (300 word maximum)Student SignatureMy signature serves as permission for the Coastal Community Foundation to publish my name and photos in the event I receive a scholarship. Furthermore, I agree to release and hold harmless the Foundation.Date Date Format: MM slash DD slash YYYY CAPTCHACommentsThis field is for validation purposes and should be left unchanged.