Scholarship Application
Page 1
Appl.#____________
The applicant must complete this form. Sign this sheet and have a parent or guardian approve the
application. Answer all questions. If a question does not apply, write "none" in the space provided.
NAME OF APPLICANT (Please print)
______________________________________________________
First
Middle
Last
STREET ADDRESS: ______________________________________________________
CITY, STATE, ZIP: ____________________________________________________________
NAME OF SECONDARY OR HIGH SCHOOL: _____________________________________
YEAR OF GRADUATION: __________________DATE OF BIRTH: ____________________
TBCPOA MEMBER: ___________________________________________________________
Mother's Full Name: ______________________Father’s Full Name: ______________________
What is your relationship to the TBCPOA member?_______________________________________
After the application is received and acknowledged this sheet will be placed in a sealed envelope and
not opened until after the selection has been made. The Scholarship Committee will not have any
knowledge of this information during the selection process. Applications not selected are destroyed.
___________________
Home telephone number
I certify that the information herein is complete and accurate to the best of my knowledge and belief.
Signature of Applicant
Date
Signature of parent or guardian
Date
I approve the submission of this application.
Signature of school counselor
2005 6th Place SW, Largo, FL 33770, PH: 727-581-3341
or 727-804-5227
Date
Appl.#_______________
Page 2
I.
General Information
Name and address of high school/college:
__________________________________________________
_____________________________________________________________________________
Year of Graduation: ______________________
Ask your Guidance Counselor to attach a copy of your official transcript (in a sealed envelope) to
this application. This is a requirement in applying. Be certain that the Guidance Counselor signs the
transcript.
Name and address of the school you are enrolled in or intend to enroll in for the next academic year:
_____________________________________________________________________________
_____________________________________________________________________________
Have you been accepted ? _______________________________________________________
How long is the course of study ? _________________________________________________
When do you expect to finish ? ___________________________________________________
Briefly describe the course of study: _______________________________________________
_____________________________________________________________________________
What are your plans for the summer ? ______________________________________________
____________________________________________________________________________
What are your career plans ? _____________________________________________________
____________________________________________________________________________
___________________________________________________________________________
2005 6th Place SW, Largo, FL 33770, PH: 727-581-3341
or 727-804-5227
Page 3
Appl.#__________
II.
Academic and Extra Curricular Information
What course of study have you followed in high school/college (e.g., college preparatory, business,
industrial, etc.): ________________________________________________________________
____________________________________________________________________________
High School class standing ______________________ of _______________________________
(Even if currently enrolled in college)
Have you taken the College Board Examinations ? __________ If “yes” list subjects and Scores:
Subject
Aptitude Score
Achievement Score
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
List honors, awards, prizes or distinctions received: ___________________________________
____________________________________________________________________________
____________________________________________________________________________
In what school activities have you participated ? List any offices you have held.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
2005 6th Place SW, Largo, FL 33770, PH: 727-581-3341
or 727-804-5227
Page 4
Appl.#_________
Describe any other group activities in the community in which you have participated and list any
offices held in organizations:
____________________________________________________________________________
____________________________________________________________________________
List and describe your hobbies and outside interests: __________________________________
____________________________________________________________________________
____________________________________________________________________________
Describe any extraordinary responsibilities you have at home: __________________________
____________________________________________________________________________
____________________________________________________________________________
What work experience have you had ? _____________________________________________
____________________________________________________________________________
III.
Submit an essay of 500 words or less on the importance of Service. (Community, Military,
Civic, Charitable, etc.)
IV.
Should you be selected to receive the TBCPOA Scholarship, we would like your permission
to include portions of your application and your essay in our scholarship book. This book is available
for members to review. We may also print portions of your essay and application in various other
association communications and publications. Your signature below will indicate your approval.
________________________________________________
Signature of applicant
Please return the completed application to:
Scholarship Committee
Tampa Bay CPO Association
At below address:
2005 6th Place SW, Largo, FL 33770, PH: 727-581-3341
or 727-804-5227