Please read this form carefully and answer each question completely. Personal Information Name * First Last Address * Street Address Address Line 2 City State/Province Postal Code —Please choose an option—AfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsChadChileChinaColombiaCongoCook IslandsCosta RicaCote D IvoireCroatiaCruise ShipCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaFrench West IndiesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuamGuatemalaGuernseyGuineaGuinea BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKuwaitKyrgyz RepublicLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMauritaniaMauritiusMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueNamibiaNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint Pierre & MiquelonSamoaSan MarinoSatelliteSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSouth AfricaSouth KoreaSpainSri LankaSt Kitts & NevisSt LuciaSt VincentSt. LuciaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor L'EsteTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & CaicosUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVenezuelaVietnamVirgin Islands (US)YemenZambiaZimbabwe Country Phone * Email * Where did you get information about this scholarship? Are you under 18 years of age? * YesNo Personal Scholarship Info Where do you currently or plan to attend college/trade school? College/University or trade school mailing address Street Address Address Line 2 City State/Province Postal Code —Please choose an option—AfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsChadChileChinaColombiaCongoCook IslandsCosta RicaCote D IvoireCroatiaCruise ShipCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaFrench West IndiesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuamGuatemalaGuernseyGuineaGuinea BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKuwaitKyrgyz RepublicLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMauritaniaMauritiusMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueNamibiaNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint Pierre & MiquelonSamoaSan MarinoSatelliteSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSouth AfricaSouth KoreaSpainSri LankaSt Kitts & NevisSt LuciaSt VincentSt. LuciaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor L'EsteTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & CaicosUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVenezuelaVietnamVirgin Islands (US)YemenZambiaZimbabwe Country Have you been accepted? —Please choose an option—YesNoCurrently Enrolled Planned/Current field of study: Carhartt jacket size: —Please choose an option—SMLL-TallXLXL-Tall2XL2XL-Tall3XL3XL-Tall4XL4XL-Tall Please spell your name as you would like it to appear embroidered on your jacket: Activities/Organizations Please list activities and organizations you have been involved with in school and outside of school. Indicate any offices held and accomplishments while in office, if applicable. Honor/Awards Please list any honors or awards received during high school/college. Work Experience Please list both paid and volunteer work experience and job duties performed. Please indicate your expected resources for the upcoming academic year: (Example: Your job, savings, parents, and other outside assistance) Please indicate your expected expenses for the upcoming academic year: (Example: Tuition, Books, Transportation, Rent, Food, Personal, etc.) Please write a statement discussing your financial need: Please describe why receiving a scholarship is important to you: Application Requirements: 1.Letter of application addressed to the Scholarship Committee. The letter should contain a brief explanation of career goals and background information. 2. A letter of recommendation from the student’s high school teacher/college professor, administrator, coach, mentor or employer (current or prior). 3. A complete high school/college transcript with cumulative grade point averages and a class standing/rank. Please merge your letter of application, recommendation, and transcript into one PDF with the applicant's name in the file title. Or compress your files using ZIP and upload that. Maximum file size is 16MB. Printed name * Date *
