KHS Lady Chiefs' Booster Club Scholarship

Kickapoo High School

In order to apply for the KHS Lady Chiefs’ Booster Club Scholarship you must answer yes to the following
questions:
1. Are you graduating from Kickapoo High School?
2. Are you planning to attend college?
3. Are you a female athlete of varsity softball, volleyball, tennis, or track (sports supported by the
Lady Chiefs’ Booster Club)? Your essay should address how athletics have impacted your life.
*Preferences to be considered:
1. Scholastic Ranking
2. Good citizenship
3. Leadership & personality
4. Integrity, dependability, initiative, perseverance, and seriousness of purpose?
5. Financial assistance to continue education
*Include a brief essay describing your college career plans (150 words or less), and a brief letter of
reference from each of the following: 1. Teacher, 2. Personal acquaintance (non-relative), and 3. One
coach.
If you answered no to any of these questions you are not eligible for this scholarship. If you answered
yes to each question you may proceed to the application.

Apply

Hidden
Your School Name*
Personal Information
First Name*
Last Name*
Date of Birth*

MM/DD/YYYY Format (ex. 07/20/1995)
Applicant Email*
Enter Email Confirm Email
Cell Number*
Street Address*
City, State*
Zip Code*
Parent/Guardian Name(s)
Parent/Guardian Name(s)*
Parent/Guardian Cell Phone*
Parent/Guardian Email Address*
Signature
By signing this application, you are verifying the accuracy of your completed form.
Student Signature: *Type your name to sign your application.*
Date:*

MM/DD/YYYY Format
Parent/Guardian Signature: *Type parent/guardian signature.*
Date:*

MM/DD/YYYY Format
Academic Information
Weighted High School GPA*
Unweighted High School GPA*
ACT Composite Score*
SAT Reading Score and SAT Math Score*
College/University Information
Educational Institute You Plan to Attend In The Fall*
City/State of Institute:*
Have you applied?*
Have you been accepted?*
What do you plan to major in?*
Leadership & Extracurricular Activities: List leadership and extracurricular activities you were involved in at your high school, starting with the most recent.*
Community Service: List any community service and dates that you have performed during high school, starting with the most recent.*
Work Experience: List jobs you have held during high school, starting with the most recent.*
Honors and Awards: List scholastic awards, extracurricular activity awards, or civic honors that you have received during high school, starting with the most recent.*
A+ And Other Scholarships Received: Including A+, please list any other financial aid including scholarships and grants that you are receiving and the amounts of each scholarship.*
Parent Financial Information
Complete the financial section based on your most recent IRS 1040. If parents are divorced or separated, answer the questions for the parent in which you applicant lived with the most in the past 12 months. If the applicant has lived with both parents an equal number of days in the past 12 months, include the parent who provided the largest amount of support to the student. If that parent has remarried, the stepparent's information must be included. If the applicant has been living independently from the parent/guardian, please indicate this. If some of the questions below are not applicable, please enter N/A in the box.
Father's Name*
Age and Occupation*
Mother's Name*
Age and Occupation*
Stepfather's Name*
Age and Occupation*
Stepmother's Name*
Age and Occupation*
Custodial Parent's Marital Status As Of Today*
Number of people in family, not including parents, who will receive the majority of parental support this calendar year. Include dependent children and other individuals living in the household who receive more than half their support from parents or guardians.*
Name and age of dependents.*
Number of dependent children, including applicant, as defined above, attending college this calendar year and taking a minimum of 8 hours of college credit.*
Based on your most recent IRS 1040, indicate the custodial parent(s) adjusted gross income. Round up to the nearest $100.*
Note- If you have extenuating financial circumstances, please explain here. (1,000 character limit)*
Student Essay
Please describe your goals for the future to show how your high school or work experiences have had an impact on you personally. Include reasons why you have applied for this specific scholarship. (3,000 character limit).*
Transcripts*
Drop files here or

Max. file size: 49 MB.
Please upload a copy of your transcripts.
Letters of Recommendation*
Please upload at least two letters of recommendation from a teacher, counselor or coach from your high school.
Drop files here or

Max. file size: 49 MB.
References
Reference 1*
Reference 1 Email*
Reference 1 Phone*
Reference 2*
Reference 2 Email*
Reference 2 Phone*
Hidden
Name of Scholarship

Kickapoo High School

Apply

Personal Information

Parent/Guardian Name(s)

Signature

Academic Information

College/University Information

Parent Financial Information

Student Essay

References

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