HENRY HARMS MEMORIAL SCHOLARSHIP APPLICATION

Name_____________________________________  Date ________________________

Address ___________________________________ Phone _______________________

Parent/Guardian __________________________________________________________

Post-secondary school you plan to attend ______________________________________

Have you been admitted? ____________  Date classes begin ______________________

Major area of intended study _______________________________________________

State your plans upon completion of your post-high school education.

List your school and community activities in which you have been involved during your high school years.  Include any work experience you might have.

List any honors and awards you have received during your high school years.

Briefly describe how you intend to finance your post-high school education.

Grade Point Average _____

Class Rank _____

ACT/SAT composite score _____

Please list three references:

_________________________________

_________________________________

________________________________

Return completed application to counselor’s office.