By MISSISSIPPI GOOD SAM
APPLICATION for 2008
$1,000.00 SCHOLARSHIP GRANT APPLICATION [two (2) will be awarded]
APPLICANT'S NAME ______________________________ SUBMISSION DATE ___________
HOME ADDRESS _________________________E-MAIL ADDRESS _____________________
HOME TELEPHONE ___________________________ DATE OF BIRTH ___________________
SOCIAL SECURITY NUMBER ____________________________ SEX ____________________
SPONSOR'S NAME _____________________________________ PARENT / GRANDPARENT
(Circle one)
SPONSOR'S GOOD SAM CHAPTER _________________ CHAPTER ADDRESS ____________
HIGH SCHOOL NAME ___________________________ TELEPHONE NO. ________________
HIGH SCHOOL ADDRESS ________________________________________________________
COLLEGE ATTENDING ___________________________________________________________
ADDRESS OF COLLEGE FINANCIAL AID OFFICE ______________________________________
ADDENDUMS NEEDED:
1. PHOTOCOPY OF OFFICIAL HIGH SCHOOL TRANSCRIPT
2. COLLEGE ENTRANCE EXAM SCORE
3. CURRENT GRADE POINT AVERAGE (as of end of first semester senior year)
4. RESUME TO INCLUDE HIGH SCHOOL AND COMMUNITY SERVICE ACTIVITIES AND WORK EXPERIENCES
5. SHORT LETTER OUTLINING HOW SCHOLARSHIP ASSISTANCE WILL HELP YOU ACHIEVE
YOUR EDUCATIONAL GOALS
ALL INFORMATION MUST BE INCLUDED WITH APPLICATION ,ONLY COMPLETED APPLICATIONS WILL BE JUDGED. APPLICATIONS SHOULD BE POSTMARKED BEFORE APRIL 1, 2008
Send Completed applications to: Sheblon "Pete" Cotten Memorial Scholarship Committee
% Larry Blaylock, 146 Quail Creek Rd. Saltillo, MS 38866 (662) 869-1081
Revised 01 16 2008
