Forms

PAR 5 GOLF CLUB SCHOLARSHIP APPLICATION FORM

PAR 5 GOLF CLUB
P.O Box 547
FORT PIERCE
FLORIDA 34950
Date of Application: ____________________________
Name: (Please Print):____________________________________________________________
Address: _____________________________________________________________________
City: _____________________ State: _____________________ Zip Code: ________________
Telephone Number: _________________ E-mail Address: _____________________________
Date of Birth: ________________________ Age: ________ Gender: ______________________
Graduating High School: _________________________________________________________
Weighted GPA: _________________ Class Rank: _____________________________________________
Father’s Name: __________________________ Occupation: ____________________________
Place of Employment: ___________________________________________________________
Mother’s Name: _________________________Occupation: _____________________________
Place of Employment: ___________________________________________________________
Number of Siblings at Home: ________________ Ages: ________________________________

Annual Family Income: (Please check one) under ( ) $15,000 ( ) $15,000- $25,000
( ) $25,000-$35,000 ( ) $35,001-$50,000 above ( ) $50,001
Are you currently employed? Yes No Where /What Position: ________________________
(Please type or print in black ink only)
School Activities:
Years involved: Name and /or Office Held
_____________ __________________________________________
_____________ __________________________________________
_____________ __________________________________________
_____________ __________________________________________

Community Activities:
Years involved: Name:
_____________ __________________________________________
_____________ __________________________________________
_____________ __________________________________________
_____________ __________________________________________

Honors/Awards:
Years involved: Name:
_____________ __________________________________________
_____________ __________________________________________
_____________ __________________________________________
_____________ __________________________________________

Colleges applied to and acceptance approval:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please submit two (2) character references from a Teacher, Guidance Counselor, or Pastor indicating why you should received this scholarship in three hundred words or more.

Please attach an essay of at least 500 words indicating your career and plans upon graduating from high school. Please type essay and double space.

This scholarship is offered to any student regardless of color, race, creed, religion, national origin, gender who meet the criteria set forth by Par 5 Golf Club.
Application Deadline April 30, 2014

Scholarship Committee Approval Dated/Signed:
_________________________________________
_________________________________________
_________________________________________

________________________________________
President’s Signature/ Date

PAR 5 GOLF CLUB IS A NON-PROFIT ORGANIZATION AND IS 501 (3) DESIGNATED.

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