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 Academic InformationName of High School Currently AttendingCumulative Grade Point Average (weighted / unweighted)What is your intended college major?What is your intended career?Please list top three to five choices of intended colleges or universities for fall 2020. The school must be accredited or licensed.One per line. Please include your top 3-5 choices.Please request a letter of recommendation to accompany your application.Name of recommenderExtra-curricular activities, community service, work experience, awards & honorsSports Please list any sports experiences during high school.Leadership & other extra-curricular activities Please list any leadership or other extra-curricular 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 StatementSteve Pratt’s personal motto was Refuse to Lose. What does this motto mean to you, and how does it apply to your athletic, academic, and personal life? (500 words maximum)Student SignatureDate Date Format: MM slash DD slash YYYY Are You At Least 18 Years Old?YesNoMy 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 Date Format: MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged. Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.