Saturday, February 4th 2012 | 8:56 PM

Corporate Information

Scholarship Information

2011/2012 Scholarship Application Form

1. Do your parent(s) or legal guardian(s) reside within a Golden West Telecommunications service area and are they a customer of Golden West? (See communities and the list of telephone prefixes under Residency Requirements.) YES NO (If you answered no, then you are ineligible)
2. Applicant's Name:
3. Parent or Guardian Name:
4. Mailing Address:
5. Name and Address of High School:
6. Class Rank:
7. GPA:
8. Home Phone Number:
9. Applicant's Social Security #:
10. School Attendance Record:
Grade 9
Grade 10
Grade 11
Grade 12
11. School Offices Held:
Grade 9
Grade 10
Grade 11
Grade 12
12. School Activities:
Grade 9
Grade 10
Grade 11
Grade 12
13. Honors and Awards:
14. Community Service and Involvement:
15. List any employment history within the past 2 years:
16. How do you plan to finance your education?
17. Post-Secondary School You Plan to Attend:
18. Major (If Known)

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