Application

100 CLUB OF BRAZORIA COUNTY SCHOLARSHP APPLICATION  2023-2024

Name of student: ____________________________________________________________________________ Address: _____________________________________________City ___________________________________ Phone: _________________________ SSN____________________________Birthdate: ________________ Email address: ______________________________________________________________________________ Name of high school: _______________________________________________________________________ College choices: (1) ___________________________________________, (2) _________________________ ___________________________________ (3) _________________________________________________________ College major: _____________________________________ Minor: ________________________________ 

Career objective: _________________________________________________________________________ What are your plans for the future: _______________________________________________________ _________________________________________________________________________________________________ Number of children in family: ___________ Ages: __________________________________________ Father’s name: ______________________________________________________________________________ Address and phone: _________________________________________________________________________ Father/guardian’s employer: ______________________________________________________________ Job title and length of service: _____________________________________________________________ Mother/guardian’s name: __________________________________________________________________ Address and phone number: _______________________________________________________________ Mother’s employer: _________________________________________________________________________ Job title and length of service: _____________________________________________________________ Your work experience, if any: ______________________________________________________________

100 Club Scholarship Application 

2023-2024

What is your approximate salary if working at present: ________________________________ Any special circumstances or conditions that indicate financial need: ________________ 

Have you applied for financial aid (FAFSA)? ______________________________________________ 

Give a brief description of your high school activities and achievements (awards,  clubs, offices held, hobbies, special interests, etc.) 

What other qualifications do you have for this scholarship? ____________________________ _________________________________________________________________________________________________

Reference: (Person who can verify this information --- preferably not a relative):

 Name :_________________________________________________________Phone: _______________________ 

Address :______________________________________________________________________________________ 

Student’s Signature:________________________________________________________________________ 

Parent signature: __________________________________________________Date: ___________________ 

Note: Applicant’s signature and/or parent’s signature will be considered permission to  release the information below. 

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  THIS INFORMATION IS CONFIDENTIAL 

TO BE COMPLETED BY THE SCHOOL OFFICIAL 

Class rank: _________ Quartile: ____________ GPA: ____________ SAT:________ ACT: _________ 

Signature of School official:____________________________________________________________

Title:_______________________________________________________________________________