PTSA Scholarship

Student Name (required)

Student Phone Number (required)

Student Email (required)

Parent Name (required)

Parent Phone Number (required)

Parent Email (required)

College or University You plan to attend. (required)

(If you are selected as one of the scholarship recipients, you will be required to provide a copy of your acceptance letter.)

STUDENT ESSAY:

Please write a short essay (max of 300 words) to the following question. DO not include your name or any personal identifying information in your essay. Essay's including this information are subject to disqualification.

What have you done during your High School Years to give back to your school, PTSA or local community? (required)

Student Volunteer Work-list up to five:

Please describe (max 100 words per volunteer task) in detail the types of volunteer work you have been involved with during your high school years. Please include organization name, your responsibilities, amount of time invested, any leadership role you played and impact of your efforts.

Additionally, please include the following information for a reference that can validate your volunteer efforts:

Reference Name (type full name) (required)

Organization Name (required)

Reference Phone Number (required)

Reference Email (required)

Optional second volunteer reference:

Reference Name (type full name)

Organization Name

Reference Phone Number

Reference Email

__________________________________________________________________________________________

Student E-Signature (type full name) (required)

Date of Student E-Signature (required)