PATRICK W. CLEVELAND SCHOLARSHIP

STUDENT APPLICATION FORM

The Patrick W. Cleveland Memorial Scholarship is available to a graduating senior of Carter County High School, who participated in athletics during their high school years.  Applications will be reviewed by a scholarship committee and a recipient will be named at the annual Awards Night.  Please feel free to attach additional sheets if your responses do not fit into the space provided.

NAME _________________________________________________________________

                             LAST                      FIRST                    M.I.

DATE OF BIRTH ____________________ DATE OF GRADUATION_________________

                                  MONTH   DAY    YEAR                                   MONTH   DAY  YEAR

PARTICIPATION IN EXTRACURRICULAR ACTIVITIES (include year, ex. Band 2,3,)

HONORS, AWARDS, OFFICES HELD AND YEAR

COMMUNITY ACTIVITIES

INTENDED SCHOOL AND MAJOR COURSE OF STUDY

CAREER GOALS AFTER GRADUATING FROM COLLEGE/VO-TECH

PLEASE ATTACH A 100 WORD ESSAY ON THE FOLLOWING TOPIC: "What my extracurricular involvement at CCHS has meant to me."

I certify that I have answered all the questions accurately and to the best of my knowledge.

______________________________________________________________________

SIGNATURE OF APPLICANT                                     DATE