2019 Application
Applicant’s Name: _______________________________________________
Home Phone Number: __________________ Cell Phone Number: _____________________
Birth Date: __________________________
Address: _______________________________________________________
Resident of: (Check all that apply) _____ Pickerington Local School District _____ Violet Township
High School: Pickerington Central _____ Pickerington North _____ Other_______________________
(Unweighted) Grade Point Average: __________
Parent/Guardian: ______________________________________________
Preferred Institute of Higher Learning: __________________________________________________________
Address___________________________________________________________________________________
Intended Major: _______________________________________________
Interests and Extra Curricular Activities: (Attach a separate sheet, if necessary) __________________________________________________________________________________
__________________________________________________________________________________
Community Service Experience: (Attach a separate sheet, if necessary, and include the average time spent per month on each activity listed) __________________________________________________________________________________
======================================================================================================================
How did you learn about the VTWL Scholarship? ________________________________________________
I agree that all submitted information is true and accurate.
Student Signature_________________________________________
Parent/Guardian Signature___________________________________
****************************************************************************************** Committee Checklist:
_____Application _____Essay _____ 2 Letters of Recommendation _____Proof of Admission
Application Deadline
Please submit your completed application and all supporting documents as soon as possible to: Violet Township Women’s League, P.O. Box 384, Pickerington, OH 43147.
All applications and supporting documents must be postmarked no later than March 25, 2019.