JUNIOR ACHIEVEMENT SCHOLARSHIP APPLICATION
Sponsored by Junior Achievement of East Texas, Inc.
Required Attachments:
1. High School Transcript
2. Cover letter to Scholarship Committee. Include in the letter reasons why you should be awarded a
scholarship. Those items might include scholastic accomplishments and merit achievements,
experiences or courses supporting your major or need, etc. Explain goals for college and beyond.
Scholarship application & required attachments due to:
JUNIOR ACHIEVEMENT OF EAST TEXAS
911 NW Loop 281, #211-16
Longview, Texas 75604
March 31, 2016
The questions that follow are designed to collect information about your background, your interests, and your plans. Your answers to
these questions as well as the required high school transcript attachment for this scholarship program will be divulged only to those
qualified persons who must see them in the course of their duties. NOTE: The selection of scholarship recipients will be influenced
by the completeness of replies, neatness, legibility, proper grammar, punctuation, and spelling. Please type or print using black ink,
and PROOFREAD your entry carefully. Please do not include resumes, references, letters, etc.
DATE_____________________
FULL NAME_______________________________________________________________________________________________
(LAST)
(FIRST)
(MIDDLE )
EMAIL: ___________________________________________________________________________________________________
HOME PHONE: _________________________________________________CELL PHONE: _______________________________
HOME ADDRESS_______________________________________________________________ZIP CODE __________________
SOCIAL SECURITY NUMBER____________________________________________ BIRTHDATE ________________________
NAME OF HIGH SCHOOL____________________________________________________________________________________
HAVE YOU APPLIED FOR ADMISSION TO A COLLEGE OR UNIVERSITY? _________________________________________
If yes, indicate your choice of program: ________________________________________________________________________
A. Family Information:
Father's Name_______________________________________________Address__________________________________________
Occupation___________________________________________Employer_______________________________________________
Mother's Name______________________________________________Address__________________________________________
Occupation___________________________________________Employer_______________________________________________
Number of dependent children including applicant_______________________
B. Your Junior Achievement Activity:_______________________________________________________
Classroom teacher________________________________________Consultant__________________________________________
C. Your Activities and Work Experience (limit choices to space provided on form):
List activities you have participated in at your school (such as publications, debate, theater/drama, music, art, student government and clubs):
Activity
Grades participated
Offices held
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
List Sport(s) participated in:
Sport
Grades participated
Special honors/awards
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
List volunteer/community work participated in:
Kind of volunteer work
Agency or organization
# of hrs. per week
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
List jobs (including summer employment) you have worked during the past four years:
Job/Kind of work
Employer
# of hrs. per week
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
D. What’s Your Opinion?
On a separate typed sheet, please answer the following questions:
1. What influence has Junior Achievement had on you and your college plans?
2. Why do you feel that it is important to continue your education on a college level?
3. Detail any other information or circumstances which you deem important to the consideration of your
application.
Please read the following and sign below:
I certify that the information contained in this scholarship application is correct to the best of my knowledge,
and understand that falsification of this information is grounds for disqualification in the scholarship program.
__________________________________________________
Applicant's Signature
________________________
Date
__________________________________________________
Parent/Guardian Signature
________________________
Date