COLLEGE/UNIVERSITY SCHOLARSHIP

1. Name

First Name *This question is required.

Middle Name

Last Name *This question is required.

2. Contact Information

Telephone # *This question is required.

Email *This question is required. This question requires a valid email address.

3. Present Address

Street *This question is required.

City *This question is required.

State *This question is required.

ZIP *This question is required.

4. Permanent Address

Street *This question is required.

City *This question is required.

State *This question is required.

ZIP *This question is required.

Birth Date *This question is required.

Place Of Birth *This question is required.

Gender *This question is required.

Marital Status *This question is required.

Dependent Children *This question is required. This question requires a valid number format.

7. Parents's Information

Name(s) *This question is required.

Address *This question is required.

Occupations(s) *This question is required.

8. Names Of Siblings

Name

Age This question requires a valid number format.

School Attending

Name

Age This question requires a valid number format.

School Attending

Name

Age This question requires a valid number format.

School Attending

9. How did you hear about the Joseph Shinoda Memorial Scholarship program? *This question is required.

10.

College you are now attending *This question is required.

Anticipated graduation date *This question is required.

Degree sought *This question is required.

Major *This question is required.

Area of concentration *This question is required.

Present Student Status *This question is required.

Cumulative GPA (You will be required to submit transcript of grades with this application - you can upload copy in last section, before submitting.) *This question is required. This question requires a valid number format.

Next year in school *This question is required.

11. List extracurricular college activities including clubs and organizations to which you belong *This question is required.

12. List any academic honors or scholarships you received in college: *This question is required.

13. For what business or profession are you preparing? *This question is required.

14.

Have you previously applied to us for a scholarship? *This question is required.

When?

15. Have you had any experience in the florist or floriculture industry? *This question is required.

Please describe experience

Dates *This question is required.

Organization *This question is required.

City *This question is required.

State *This question is required.

Activities *This question is required.

Dates

Organization

City

State

Activities

16. Are you presently employed? *This question is required.

Please give name and address of employer, hours worked per week and brief description of duties:

Employer's Name *This question is required.

Employer's Address *This question is required.

Hours Worked Per Week *This question is required. This question requires a valid number format.

Duties *This question is required.

17. Do you expect to work during the coming summer vacation? *This question is required.

Please give name and address of your summer employer, hours worked per week and brief description of duties:

Summer Employer's Name *This question is required.

Summer Employer's Address *This question is required.

Hours Worked Per Week *This question is required. This question requires a valid number format.

Duties *This question is required.

Please detail your plans for the summer *This question is required.

COLLEGE/UNIVERSITY SCHOLARSHIP

APPLICATION