Scholarship Application Name First Name Last Name Gender * Male Female Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * School * SHS Student Polaris Student PSOE Student Student Of Other School Which School If "Student Of Other School" Parent / Guardian Name * First Name Last Name Their Email * Parent / Guardian Name First Name Last Name Their Email What School Do You Plan On Attending In The Fall? * Intended Field Of Study * Have You Been Accepted? * Yes No Will You Be Receiving Financial Assistance From Any Sources Other That Yourself Or Your Parents? * Yes No If Yes, What Sources? Community Service / Volunteer Work Type Of Work In What Ways Have You Been Involved In Supporting Local Businesses Or Community Initiatives? Have You Taken On Any Leadership Roles In Your Job Or In The Community? If So, Describe Your Responsibilities And The Impact Of Your Leadership. Address Address 1 Address 2 City State/Province Zip/Postal Code Country Supervisor Phone (###) ### #### Dates Of Service Hours Per Week Community Service / Volunteer Work Type Of Work In What Ways Have You Been Involved In Supporting Local Businesses Or Community Initiatives? Have You Taken On Any Leadership Roles In Your Job Or In The Community? If So, Describe Your Responsibilities And The Impact Of Your Leadership. Address Address 1 Address 2 City State/Province Zip/Postal Code Country Supervisor Phone (###) ### #### Dates Of Service Hours Per Week Community Service / Volunteer Work Type Of Work In What Ways Have You Been Involved In Supporting Local Businesses Or Community Initiatives? Have You Taken On Any Leadership Roles In Your Job Or In The Community? If So, Describe Your Responsibilities And The Impact Of Your Leadership. Address Address 1 Address 2 City State/Province Zip/Postal Code Country Supervisor Phone (###) ### #### Dates Of Service Hours Per Week Community Service / Volunteer Work Type Of Work In What Ways Have You Been Involved In Supporting Local Businesses Or Community Initiatives? Have You Taken On Any Leadership Roles In Your Job Or In The Community? If So, Describe Your Responsibilities And The Impact Of Your Leadership. Address Address 1 Address 2 City State/Province Zip/Postal Code Country Supervisor Phone (###) ### #### Dates Of Service Hours Per Week High School Activity Club / Organization Advisor Phone (###) ### #### Office Held Office Title Dates Of Participation High School Activity Club / Organization Advisor Phone (###) ### #### Office Held Office Title Dates Of Participation High School Activity Club / Organization Phone (###) ### #### Office Held Office Title Dates Of Participation High School Activity Club / Organization Advisor Phone (###) ### #### Office Held Office Title Dates Of Participation Employment Employer Address Address 1 Address 2 City State/Province Zip/Postal Code Country Supervisor Phone (###) ### #### Responsibilities Dates Employed Hours Per Week Thank you! We will get back with you shortly. Become part of the Strongsville Chamber of Commerce and experience the power of community support and networking. SIGN UP
