SCHOLARSHIP APPLICATION
Please TYPE or PRINT LEGIBLY. You may attach additional pages if necessary. The completeness, neatness, and
legibility of your responses will allow for a complete and comprehensive review of your information.
NAME OF APPLICANT (use legal name only)
______________________________________ ___________________________
(Last)
(First)
______
(MI)
PERMANENT HOME ADDRESS
_________________________________________________
(Number and Street)
_______________________________________
(City)
__________
(County)
________
(State)
______________
(Zip Code)
PHONE (with area code) _____________________ DATE OF BIRTH: ____/____/____ GENDER  Male  Female
E-MAIL___________________________ CLUB ATTEND(ED) _______________CLUB MEMBER SINCE ______
Tallman Scholarship – Est. 1942 advanced education for deserving youth.
William O. & Marie Frank Cotty Engineering Scholarship-Est.1974 member studying engineering at Univ. of DE.
Professional Career Scholarship – CEO Scholarship for individuals considering a career in BGCD or Non-Profit
Craig Kelly Scholarship – Est.1998 in memory of staff member for club youth.
Laurence Davis Scholarship- Est. for club members of the Clarence Fraim Boys & Girls club.
Wilmington University Scholarship – 4 yr. undergraduate degree for youth attending Wilmington University
Margaret & Ernest Zimmerman Scholarship – for Club members who reside in and around the Dover community
In what way will the award be used? (i.e. tuition, room/board, books) ______________________________
*more information about the different scholarship funds can be found at www.bgclubs.org/scholarships
EDUCATION
Are you currently a high school senior?  Yes  No
HIGH SCHOOL NAME
_______________________________________
SCHOOL DISTRICT
Enter your anticipated COLLEGE graduation date__________
_______________________________________
COLLEGE OR UNIVERSITY YOU PLAN TO ATTEND
CITY
STATE
________________________________________________
_________________________
_______
CAMPUS CITY/LOCATION
STATE
____________________________
_______
Enter your HIGH SCHOOL graduation date ________ What is your planned major/course of study? _____________
List special courses or programs you have taken during the last three years. List the most recent course or program first
(AP, Honors, International Baccalaureate, computer certification, electronics, etc.)
Course or Program
Name of School
Dates of Attendance
SCHOOL AND COMMUNITY ACTIVITIES
List activities in which you have participated during the last three years. (School clubs, student government, varsity or
sports clubs, Key Club, 4-H, etc.)
Activity
Dates of Participation
Office/Position Held
Awards or Honors
List community agencies or organizations in which you have participated without pay during the last three years.
(Religious groups, hospital volunteer, cultural activities, outreach programs, etc.)
Name of agency or organization
Kind of Activity
Dates of Participation
# of Hours per year
If you listed a leadership role in one or more of the activities or organizations cited above, please choose one, detail
your responsibilities, and explain the significance of your contribution to the organization.
List jobs (including summer employment) you have held in the last three years.
Employer or Type of Business
Job Title or Description
Dates of Employment
Hours per Week
FAMILY INFORMATION
Enter complete information about your family below.
Parents/Guardian/Other Father/Guardian_______________________ Mother/Guardian_____________________
Brother(s): Number_____ Age(s) __________________Sister(s): Number______ Age(s)_______________
Enter the name(s) of the parent(s) or guardian(s) ____________________________________________
or other person(s) you live with, if different from above.
FUTURE GOALS
Based on your current achievements and interests, describe the kind of work that you plan to be doing in 10 years?
REQUIRED ESSAY (Include as attachment)
What Does The Boys & Girls Clubs Mean To Me?
RECOMMENDATION REQUIRMENT
One letter of recommendation is required for all applicants, regardless of scholarship fund requested. This letter of
recommendation must come from either a Boys & Girls Clubs of Delaware staff person or a BGCDE Corporate or Unit
Board member. Please attach letter to application.
ADDITIONAL REQUIRED INFORMATION
High School Seniors: Your official high school transcript with grades through December.
College Students: Your official college transcript with Fall semester grades.
AUTHORIZATION/CERTIFICATION
Please review your responses and sign your name below. If you are under 18 years of age, please have your
parent/guardian sign as well.
I hereby certify that all information entered on this form is accurate and true. I understand that false or misleading
statements will result in disqualification from scholarship consideration.
Student’s Signature ___________________________________________________
Date ___________________
Signature of Parent/Guardian ___________________________________________
Date ___________________
ATTACHMENTS: Reference letter from BGCDE staff or board member, high school or college transcript, most current
copy of FAFSA Student Aid Report and IRS Form 1040. Although not necessary you may attach a resume, list of
accomplishments/honors etc. or other support items you believe would be of benefit to the selection committee.
IMPORTANT: Your application will not be considered complete unless all required materials are received by The
Scholarship Fund Committee.
*Scholarships will be awarded after letter of acceptance from college or university is received.
Please return application and other required materials by May 31 to:
Lisa Lynch
Boys & Girls Clubs of Delaware
1 Positive Place,
Bear, DE 19702
(302) 836-6464 Ext. 16
llynch@bgclubs.org
Note: All information supplied by applicant will be kept confidential and used only in the selection process.