Scholarship Application | Boys & Girls Clubs Of The Northland

"*" indicates required fields

Full Name*

First Middle Last

Email Address*

Home Address

Street Address Address Line 2 City State ZIP Code

Home Phone Number*

Cell Phone/Alternate Phone Number

Date of Birth*

Parent/Legal Guardian Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

School Name*

Graduation Date*

Your Student Advisor*

Grade Point Average*

Class Standing*

Honors Received

Extra-Curricular Activities

Other organizations you have participated in

Church, community, etc.

Boys & Girls Club branch you attend(ed)*

Number of years you've been a club member*

List participation in club activities*

Current Employment Status*

Choose all that apply

Not employed

Currently employed

Plan to work during school

Employer*

Position*

How long have you worked here?*

How many hours per week?*

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