dynamic-content-widget-85e7a20-3e5fda8 – C. Waldo Scott Center for H.O.P.E.

Part A-General Information

Applicant Email Address: *

First Name *

Middle Initial *

Last Name *

(Mailing Address) Street *

City *

State *

Zip Code *

Phone Number *

Date of Birth: *

Name of high school and city: *

College(s) to which you have applied: *

Have you been accepted for admission to a college? *

Yes

If yes, name of college(s)

Name of college you plan to attend:

Part B - Residency Information

Are you a U.S. citizen? *

Yes

Are you a resident of the Commonwealth of Virginia? *

Yes

If yes, how many years have you lived in Virginia:

Name of Parent or Guardian (1): *

Mailing Address, if different than applicant

Street

City

State

Zip Code

Place of Employment:

Phone Number

Name of Parent or Guardian (2):

Mailing Address, if different than Parent/Guardian 1

Street

City

State

Zip Code

Place of Employment:

Phone Number:

How many persons are residing in your household? *

How many are enrolled in college? *

Total household income? *

Part C - Achievements

List your involvement in extra-curricular activities, community and civic activities, to include activities participated in at the C. Waldo Scott Center *

List any high school or other scholastic accomplishments you have achieved *

Part D - Essay

Please submit a typed essay with at least 500 words to describe your educational and career goals and how the financial award will benefit your achievements. Attach your essay to the application. *

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Part E-Verifications

Please provide the following information and documents:

Official high school transcript *

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Cumulative GPA *

Class Rank *

Of *

SAT or ACT Scores

Critical Reading *

Math *

Total *

Copy of SAT/ACT Scores

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Part F - Certification

I certify that the information I have provided above is true: *

Date *