BOB CHERNEY MEMORIAL SCHOLARSHIP
Applicant’s Application Form
Name: _____________________________________________________________
(First)
(Middle)
(Last)
Current Address: ____________________________________________
(Street)
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(City)
(State)
(Zip)
Current Telephone Number: __________________________
Home Town: ___________________ High School: ________________________
Overall Grade Point Average: _____________ College Attending: __________________
Declared Major: ___________________ Career Objective: ________________________
Re-Application Only (college freshman): Reapplying (circle) Yes No
Why are you applying for this scholarship?_____________________________________
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Have you received any previous Honor or Awards? ______________________________
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What school and other extracurricular activities do you enjoy?______________________
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What community service have you done in the Delta area?_________________________
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Describe your career objectives:______________________________________________
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Describe your goals and how they will apply to your career objectives:_______________
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Do you have any experience in the field of your career objective? State whether or not
experience was paid or volunteer: ____________________________________________
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Where do you hope be in 10 years:____________________________________________
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List other interests: ________________________________________________________
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