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Scholarship Application
Personal Information
First Name
Last Name
Sex
Age
Ethnicity
Cell Phone
Street Address
City
State
Zip Code
Email
Educational Information
Name of High Currently Attending school
Parental Information
Mother
Full Name
Mobile Number
Street Address
City
State
Zip Code
Occupation
Email
Father
Full Name
Mobile Number
Street Address
City
State
Zip Code
Occupation
Email
Family Information
Number of children (under 18) who are dependent on parents’ financial support:
Number of adults dependent on parents’ financial support:
List the age of the dependent children:
Do you contribute to your household finances? If so, how much a month do you contribute approximately?
Describe any existing conditions that are causing unusual financial expenditures for any dependents listed above. Ex: illness, dental work, support of family by only one parent, etc.
Financial Information
Please check approximate annual gross income in the home before deductions. Include all sources of income except earnings of minors in part-time employment.
$0 to $15,000
$15,001 to $30,000
$30,001 to $45,000
$45,001 to $55,000
$55,001 to $65,000
$65,001 to $75,000
$75,001 to $85,000
$85,001 to $95,000
$95,001 and above
College Information
Please list in order of preference:
First College Choice
Second College Choice
Third College Choice
Majors Being Considered
What are your career plans after college?
Significant Employment/Internship Information (list up to 3)
Name of Employer
Position
Dates
Average Hours Per Week
Weekly Salary
Name of Employer
Position
Dates
Average Hours Per Week
Weekly Salary
Name of Employer
Position
Dates
Average Hours Per Week
Weekly Salary
Extracurricular Activities Information
Scholastic Awards
(Ex. Trustee, Honor Roll, History Award)
Athletic Awards
(Ex. Track Team, Volleyball Captain)
Other Extra-Curricular Activities, Awards, or Honors
(Ex. Band, Eagle Scout)
Hobbies, Talents, or Interests not listed above
(Ex. Piano lessons, youth groups)
Required Attachments
Official Transcript
Personal Statement
Letter of Recommendation 1 (from school faculty or staff)
Photo (optional)
Letter of Recommendation 2
If you have any questions or need technical assistance, please email
foundation@austinblacklawyers.org
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