Scholarship Application

Full Name (required)

Email Address (required)

Street Address

Street Address Line 2

City

State

Zip Code

Daytime Phone

Evening Phone

Name of Business

Type of Business

How Many Years in Business

Number of Employees Other Than Self

Website (If Applicable)

Associations, Committees or Boards you serve on (business, civic, community, fraternal, political, professional, recreational, religious, social or any other)
Name

Role/Title

Dates of Service

Name

Role/Title

Dates of Service

Name

Role/Title

Dates of Service

Essay: Contents of essay not to exceed 600 words and to include the following information:

Describe your type of business, your market segment and your business' potential,
Describe what differentiates your business from other similar businesses,
Elaborate on how you made the decision to go into business and why you chose the industry you are in,
Describe your business skills, qualifications and knowledge and how receiving scholarship funds might help you attain additional skills,etc. that will allow your business to succeed and thrive,
Explain your short -term goals (6-12 mo) and long term goals (5 yrs) and how you plan to achieve those goals.

Personal Essay (max 600 Words)

References: Please provide three written/signed personal references from individuals not related to you that include name, address, phone and email address.
Attach your Personal Reference #1

Attach your Personal Reference #2

Attach your Personal Reference #3

Δ