Joe DeCamp Memorial STEM Scholarship - Coastal Community Foundation

Personal Information
Name*
First Name Middle Last Name
Address
Street Address Address Line 2 City State ZIP Code
Cell Phone
Email
Please request a letter of recommendation to accompany your application.
Name of recommender
Academic Information
Name of High School Currently Attending
Cumulative Grade Point Average (weighted / unweighted)
SAT or ACT Score
What is your intended college major?
What is your intended career?
Please list colleges or universities to which you have been accepted.
One per line.
If you have not heard yet, please list top three to five choices of intended colleges or universities for fall 2020.
One per line. Please include your top 3-5 choices.
Extra-curricular activities, community service, work experience, awards & honors
Scouting

Please list any scouting experiences during high school.
Leadership & other extra-curricular activities

Please list any leadership or other extra-curricular experiences during high school.
Community Service Activities
Name of Organization Dates (from/to) Average hours per month Activities / Positions

Please list any involvement with nonprofit, community, civic and/or faith-based organizations during high school.
Work Experience/Internships
Name of Business Dates (from/to) Average hours per month Positions / 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.
Personal Statement
Please explain how the Ideals of Scouting—Duty to God, country, others, and self—have impacted your life and share your future goals. (500 words maximum)
Student Signature
Date
Date Format: MM slash DD slash YYYY
Are You At Least 18 Years Old?
- Yes
- No
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.
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Parent/Guardian Information
Name
First Name Middle Last Name
Phone
Email
Parent/Guardian Signature
Date
Date Format: MM slash DD slash YYYY
Name
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Name of Organization	Dates (from/to)	Average hours per month	Activities / Positions

Name of Business	Dates (from/to)	Average hours per month	Positions / Responsibilities

Personal Information

Academic Information

Extra-curricular activities, community service, work experience, awards & honors

Parent/Guardian Information