Jacob Perry Scholarship Form Step 1 of 4 25% Applicant's Name(Required) First Middle Last Suffix Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Name of school where you graduated 8th grade(Required)Name of high school(Required)Name the college/university where this scholarship will be applied(Required)Intended major(Required)Intended Minor (if applicable)Do you plan to participate in performing arts at college and if so, what (band, choir, dance, theater, etc.)?(Required)Briefly describe why you have chosen this major:(Required) List the various school-related activities (band, choir, sports, student council, etc.) that you've participated in while in high school. For each activity, list the years of involvement and positions held. Please be sure to list any awards that you have received.List academic honors (National Honor Society, Honor Roll, etc.List all community/non-school activities you are involved in (charitable work, Scouts, church, etc.)List all employment you have held including employment datesList any certifications you currently hold especially those related to your intended major (First Aid, CPR, CNA, etc.) What is your GPA?(Required)Please upload a non-relative letter of reference(Required)Max. file size: 250 MB.Consent to use name and information(Required) I consentI understand that my name and information from my academic history may be released to the scholarship selection committee and scholarship donor(s). If awarded a scholarship, I release to the Community Foundation of Grundy County the right to arrange a meeting with the donor(s) and use my name, story, and picture for printed and video promotions relating to the scholarship, and I recognize the obligation to communicate a letter of thanks to the donor(s) of the scholarship. Certify(Required) I certifyI certify that the statements herein are true to the best of my knowledge and grant my permission for the information contained herein to be shared with the scholarship selection committee and donors(s). Electronic Signature (Please type name consenting to the above statements)(Required)NameThis field is for validation purposes and should be left unchanged.
