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) High school transcripts are requested for this scholarship. Unofficial copies are accepted. Yes, I have sent transcripts via email to: scholarships@coastalfoundation.org What is your intended college major? What is your intended career? Please list top three colleges or universities for fall 2023. The school must be accredited or licensed.One per line. Please include your top 3 choices.Please list any financial aid, grant or scholarships you have already received for the 2023-2024 college academic year and other scholarships you have applied for this year. (Indicate amount received or applied).Name 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.Personal StatementPlease describe your educational and career goals. (500 word maximum)Student SignatureDate 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.CAPTCHAParent/Guardian InformationName First Name Middle Last Name PhoneEmail Parent/Guardian SignatureDate MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
