Lucille L Staples Business/Journalism Scholarship

This scholarship is available to a graduating senior from Columbia City High School planning on attending a college or university in pursuit of a baccalaureate degree in Business or Journalism.

Lucile Staples 1

Lucile Staples 2

Instructions

You will not be able to save this application or come back to it later. If you close out your browser, you will need to start your application over.

Please review this form and have your responses ready. It is advised to prepare your answers in advance. You may also copy and paste your answers from Microsoft Word or other text based programs.

Applicant Information

Name*

Address*

City State Zipcode*

Date of Birth*

Email*

Re-enter Email*

Telephone Number*

Last four digits of your social security number

Write a fun fact about yourself.*

Upload a picture of yourself.*

Family Information

Father

Please check whom you are living with

Address

Place of Employment/Occupation

Education

Mother

Please check whom you are living with

Address

Place of Employment/Occupation

Education

Number of siblings and their ages

Financial Information

Total household income for the past calendar year*

Please detail how you plan to finance your education and note how much support you will be receiving from sources such as relatives, employment, scholarships, grants etc.*

Extracurricular Activities

Please list any clubs, teams, or groups (school, church, community, etc) you have been involved in and check the years you have actively participated in the program, along with any awards/special achievements you've made in these clubs.

Work Experience

Please provide your employment history

College Plans

College or University you plan to attend

Planned Field of Study

What factors have contributed to your decision to attend this univerisity and pursue the aforementioned planned field of study?

Academic Information

Grade Point Average

Current high school class standing*

SAT scores excluding reading

Transcript

Please provide a copy of your transcript*

Certification

I hereby affirm that the information provided in this application is accurate and complete to the best of my knowledge*

Security

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Lucile Staples 3