Name (last, first,
middle):______________________________________________________________
Applicant's Student
Number: ___________________________________________________________
Sex M______ F_______
Date of Birth: _____________________________________________
Place of Birth:
_____________________________________________
Applicant's Relationship to the Post 91 Sponsor:
Sponsor's Name:
___________________________________________________________________
Sponsor's Post 91 Member
Number: _______________________________________________________
Sponsor's Current Post 91
membership type and status: Life:____ Annual Dues _____ Current Y: ___ N: ___
Home Mailing Address and Telephone Numbers (this is where
mail to you will be sent if you do not list a permanent address)
Number and Street:
__________________________________________________________________
City State Zip:
_______________________________________________________________________
Home Telephone Number:
( ) ____ -_____
Work Telephone Number:
( ) ____ -_____
Permanent Address and Telephone Numbers (if different from
above)
Number and Street:
__________________________________________________________________
City State Zip:
_______________________________________________________________________
Home Telephone Number:
( ) ____ - _____
Sponsor's Address and Telephone Numbers (if different from
home address)
Number and Street:
__________________________________________________________________
City State Zip:
_______________________________________________________________________
Home Telephone Number:
( ) ____-_____
Work Telephone Number:
( ) ____ -_____
Are you enrolled in
college ROTC? (Please check one) Yes: _____ No: _____
If not, do you intend to
enroll in college ROTC? (Please check one) Yes: ____ No: ____
Statement of Certification (both signatures are required)
I certify that the
information provided in this application is accurate and complete to the best
of my knowledge. I understand that failure to provide full documentation or
falsification of credentials will result in disqualification of this
application. I agree to provide, if requested, official documentation to verify
information reported on this application. In the event that I receive a
scholarship award and elect not to attend school during the year, I will
immediately return the award to Post 91. I also understand that the decision of
the Post 91 Scholarship Committee is final.
Applicants Signature: _________________________________________________________
Date: ____________________
Sponsor's Signature: _________________________________________________________
Date: _____________________
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Provide
copies of SAT/ACT scoresheets, report cards/transcripts of all high
school/university courses indicating all courses taken and grades earned.
Also provide documentation of Class Standing if not on transcript (See
Instructions)
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List
the High Schools, Universities, Colleges and Technical Schools you have
previously attended: (list all schools)
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Institution
Name
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City
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State
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Month/Year
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Degree
Award/Year
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List
current or future accredited Post-Secondary Schools (technical or college) to
which you have applied, been accepted or are currently attending.
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Institution
Name
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Attending
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Applied
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Accepted
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Grade
You Will Be Attending Next Fall. (please check one)
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Freshman
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Sophomore
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Junior
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Senior
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List
school clubs and organizations to which you belonged) to include positions
held, dates, honors/awards. (include any civic, scholastic
honors/distinctions received)
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List
volunteer/community/church activities to include positions held, dates and
honors/awards.
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List
leadership positions held to include honors/awards.
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List
athletic participation in organized sports or similar activities to include
positions held, dates, honors/awards.
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List
any employment during each year of high school/university/college attendance
to include summer jobs.
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Month/Year
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Employer
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Position
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Hours
Per Week
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List
any additional information you feel is pertinent to this application. (e.g.
home schooling, child rearing, homemaking, etc)
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Have
you ever been convicted of any charges other than minor traffic violations?
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Yes
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No
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If
Yes, Please explain below.
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Scholarship
Essay Question (your essay maybe typed or handwritten and should not exceed
300 words) (attach your essay after this page of the application)
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If
you could change one thing in the United States today, what would it be and
how might you accomplish this change?
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FINAL CHECKLIST
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Item
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Yes
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NO
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Statement of Certification
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Attach School Transcripts
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Attach Grade Point Average
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Class Ranking Documentation
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Attach SAT/ACT Scores
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Schools, Clubs and Activities
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Volunteer/Community/Church Activities
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Leadership Positions
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Athletic Participation
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Outside Employment
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Attach Essay
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Include Current Photo
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