Personal 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 2022 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 2022-2023 college academic year and other scholarships you have applied for this yearName of aid/grant/scholarshipStatus (Indicate amount received or applied) Extra-curricular activities, community service, work experience, awards & honorsExtra-Curricular Activities Please list any school sports or leadership experiences during high school.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 during high school.Work Experience/InternshipsName of BusinessDates (from/to)Average hours per monthPositions / Responsibilities Please list any internships or work experience during high school.Honors & Awards Please list any honors or awards you have received during high school.Educational & Career GoalsIn the space below, please describe your educational and career goals.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. CAPTCHAParent/Guardian InformationName First Name Middle Last Name PhoneEmail Parent/Guardian SignatureDate MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.
