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Student Application
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Online Scholarship Application
*SHOULD ANY OF YOUR CONTACT INFORMATION CHANGE, IT IS YOUR RESPONSIBILITY TO CONTACT knoxAchieves OR RISK LOSING YOUR SCHOLARSHIP.
Name:
High School:
Street Address:
City:
State:
Zip:
male/female:
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
Graduated College
What is your mother’s highest education level?
Attended High School
High School Graduate/GED
Graduated College
Community College I will be attending (Fall 2011).
PSTCC
RSCC
WSCC
Please indicate your likelihood of attending an eligible community college.
25%
50%
100%
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 29, 2010.
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September 28, 2010
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