NORTH CAROLINA GROUND WATER ASSOCIATION
COLLEGE SCHOLARSHIP APPLICATION
Applicant:
Date:
Address:
Age:_____________
Home Phone: ________________________ Alternate Phone: ___________________
(If you’re under age 23, please provide the following information:)
Name/Address of High School: _________________________________________________
Number in Class:
Class Rank:
GPA:
Father’s Name: _______________________
Mother’s Name: __________________________
Occupation: __________________________
Occupation: _____________________________
(Complete this entire section.)
Name of college you are attending/plan to attend: ___________________________________
Have you been accepted?
Yes
No
(Attach Letter of Acceptance or Last Year’s Transcript)
If already attending a college what is your GPA? _______
In what field do you major/plan to major? __________________________________________
What curriculum are you currently taking? _________________________________________
___________________________________________________________________________
How much is the tuition for one year?
$
If you receive a scholarship, how do you plan to use it? _______________________________
___________________________________________________________________________
List any financial support you will have (i.e.: part-time/full-time employment, parents, savings,
other grants/scholarships): _____________________________________________________
Annual Household Income: ____ Less than $25,000
____ $50,000-$75,000
____ $75,000-$100,000
____ $25,000-$50,000
____ $100,000+
- - - OVER - - -
Are you a member of the NCGWA?
Yes
No
If not an NCGWA member is your father, mother, grandparent or spouse an NCGWA member?
Yes
No
(Complete this entire section. You may use additional paper if needed)
Please list involvement in high school or college clubs, sports, teams etc. and any offices held.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Please list involvement in community organizations (i.e. volunteer work, church activities etc.)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
ESSAY:
In addition to this application, submit a typewritten 500 to 1000-word essay answering the
following questions: Who am I? What is my background? Where am I now? Where am I
going? Why have I chosen this direction? Who or what inspired me to go in this direction?
What is my ultimate goal?
Send Applications to:
NCGWA
PO Box 41368
Raleigh, NC
Applications must be postmarked by April 15.
Recipients will be notified by May 1.