Name: Scholarship Application
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Scholarship Application
First Name*
Last Name*
Gender*
Date*
Email*
Phone Number*
Home Address*
School*
College Destination*
Intended Area of Study*
Father, Stepfather or Guardian*
Mother, Stepmother, or Guardian*
Total adjusted gross income-IRS form 1040 or 1040 EZ*
Parents Current Marital Status*
- Married
- Separated
- Divorced
- Widowed
- Single Parent
With whom do you live?*
If your parents are divorced, how much child support do you receive monthly $*
Number of immediate family members under the age of 18 currently living with you:*
Do you participate in a federally subsidized lunch program:*
What are your parents' cash, savings, checking worth today?*
What are your parents' investments, stocks, CD's, money market, retirement accounts worth today?*
What is your parents' home (renters write in the monthly rent amount) worth today?
If your parents own a home, what is owed on it?
If your parents own a home, what is the monthly mortgage payment?*
What is your current GPA?*
SAT Score*
ACT Score*
Please tell us about any unusual or special circumstances that affect your family’s financial situation. In other words, why do you need a scholarship?*
Please tell us about any employment or community service activities you have been involved during high school?*
Please tell us how you plan to pay this scholarship forward upon graduation from College? In other words, in what way(s) do you want to give back to the community once you graduate?*
As a Chris Hudson Scholarship Foundation student candidate, I declare that this information is correct and complete.*
Date of Student Electronic Signature*
MM slash DD slash YYYY
As Parents/Guardians, we declare that this information is correct and complete. We also understand that a copy of our tax return may be required to verify income.*
Date of Parent/Guardian Electronic Signature*
MM slash DD slash YYYY