Scholarship Application

Preferred Name*
Address*
City*
State*
Zip Code*
Phone Number*
Date of Birth
Preferred Gender/Pronouns
Current School
1. What is the name and address of the school you plan to attend or are currently attending? What is your admission status?*
2. How do you plan to finance your education?*
3. What jobs or ongoing volunteer positions have you held? What have you gained from these experiences?*
4. What are your interests, hobbies, or extracurricular activities? Please choose one and describe how it has affected your life.*
5. What would you like to be doing 10 years from now and how do you plan to achieve this?*
6. What achievement or accomplishment has made you especially proud?*
7. How has identifying, or knowing someone who identifies, as LGBTQ+ affected your life?*
8. Please list some of the groups or activities you are, or have been, active with in the LGBTQ+ community. Include names, addresses, and telephone numbers.
9. Is there anything else you would like to share with us?

Scholarship