WOMEN IN LONGVIEW, Inc.

P.0. Box 161

Longview, TX 75606

SCHOLARSHIP APPLICATION

Women in Longview, Inc. will award at least two $1,000 scholarship each to selected graduating high school senior girls. Applicants should have a strong academic background and be interested in pursuing a field of study at an accredited college, university, technical, or vocational school. Financial need, community involvement, and letters of recommendation will also be given consideration. Applicants must be U.S. Citizens. Students must be enrolled in at least 12 hours and be considered a full time student.

Please complete all areas in their entirety. If something does not apply to you, mark the area “Not Applicable.” Print or type your responses and return the application with required documents, as set out in the 2008 Scholarship Application Procedure, to Women In Longview, Inc., Scholarship Committee, P.O. Box 161, Longview, TX 75606.

NAME: ______________________________________________________________DOB:___________________

MAILING ADDRESS: _________________________________________________________________________________________________

CITY: _____________________________________STATE: ____________ZIP: _________________

CONTACT PHONE NUMBERS: (HOME) (WORK) (CELL)_______________

□ PARENT(S) □ GUARDIAN(S)

NAME: _____________________________________________RELATIONSHIP:__________________________

ADDRESS (if different from above): _______________________________________________________________

EMAIL ______________________________________________________________________________________

PLACE OF EMPLOYMENT: ____________________________________________________________________

NAME: _________________________________________RELATIONSHIP: _____________________________

ADDRESS (if different from above): ______________________________________________________________

PLACE OF EMPLOYMENT: _________________________________________________________

COLLEGE/SCHOOL YOU PLAN TO ATTEND: ____________________________________________________

MAJOR FIELD OF STUDY: _____________________________________________________________________

ACT SCORES: English _______ Math _______ SS ______ NS ______ Composite ______________

SAT SCORES: Verbal Math _______ Total ________ HIGH SCHOOL GPA ____

SENIOR CLASS RANK _____________ NO. OF STUDENTS IN SENIOR CLASS ______

COLLEGE CREDITS EARNED: ______________

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Name: __________________________

USE SEPARATE SHEET OF PAPER WHERE NEEDED, MARKING THE SUBJECT “SEE ATTACHED”

LIST HIGH SCHOOL ACTIVITIES IN WHICH YOU HAVE BEEN INVOLVED (Include office or title held):

LIST HONORS OR SPECIAL RECOGNITION YOU HAVE RECEIVED:

LIST COMMUNITY SERVICE ACTIVITIES IN WHICH YOU HAVE BEEN INVOLVED:

INDICATE FINANCIAL CONSIDERATIONS / HOW YOUR EDUCATION WILL BE FUNDED:

(This could include the number of children or family members that are supported within your household.)

LIST EMPLOYMENT I WORK EXPERIENCE:

CERTIFICATION:

I certify that all information in my application packet is correct to the best of my knowledge.

MEDIA RELEASE:

If I am the recipient of a Women in Longview, Inc. scholarship, you may release my name and information about me to the media and also include on the Women in Longview, Inc. website.

□ YES □ NO

Applicant’s Signature: _______________________________________________Date:____________________

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Name ____________________

PERSONAL STATEMENT

In 300 words or less, describe your educational goals and objectives and who or what has been the strongest influence in your life.

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