Student Application

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Student Application

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Online Scholarship Application

Name:

High School:

Street Address:

City:

State:

Zip:

male
female

Social Security #:

Birth Date:

Email:

Home Phone:

Cell Phone:

Best method of contact (please check one):

phone
text message
email

Parent(s)/Gardian(s):

Parent(s)/Gardian(s) email:

Parent(s)/Gardian(s) cell #:

Please indicate your family's maximum gross annual income.

0-$25,000
$25,001-$50,000
$50,001-$75,000
$75,000+

What is your father’s highest education level?

Attended High School
High School Graduate/GED
College or Beyond

What is your mother’s highest education level?

Attended High School
High School Graduate/GED
College or Beyond

Community College I will be attending (Fall 2010).

PSTCC
RSCC
WSCC

Potential Field of Study:

ACT Score (if taken):

Date of ACT:

Type in the case sensitive validation code.

I have read and understand the terms and conditions of this scholarship and that the information I provided is true to the best of my knowledge. I also authorizes knoxAchieves to access any and all of my financial or educational records for a period of five years from the date of this application or until, subject to the terms of any scholarship, I submit a written revocation.

Applications must be submitted to the guidance office prior to October 30, 2009.

400 Main Street, Suite 615 • Knoxville, TN 37902 • phone: 865.215.4754

Fourth Team Meeting
March 11, 2010
Fourth team meeting, March 1-March 26
Spring Break
March 29, 2010
Spring Break, March 29-April 5
Fifth Team Meeting
April 06, 2010
Fifth team meeting, April 6-April 30
ACT registration deadline
April 10, 2010
ACT registration deadline

MORE DATES »

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