Homer Chamber of Commerce
2004 SCHOLARSHIP APPLICATION
Name _______________________________________________________ Phone _________________
Address_____________________________________________________________________________
Date and Place of Birth ________________________________________________________________
Name of High School __________________________________ Graduation Date ________________
Name and Mailing address of College, University, Vocational school you plan to attend:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Educational/Vocational Goal: ___________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
School related Honors and/or Awards: ____________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Civic Honors: _______________________________________________________________________
____________________________________________________________________________________
Other Activities: ______________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Needs/Reason for Scholarship: __________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
I certify that the above information is true and
correct. I understand that any false
information or deliberate omission on this application may be grounds for
rejection of this application and withdrawal of any award granted.
_____________________________________ ____________________________________
applicant date
LATE OR INCOMPLETE APPLICATIONS WILL NOT
BE CONSIDERED. DO NOT ATTACH PHOTOS.
Completed applications must be received by the Homer
Chamber of Commerce by
