Scholarship Application

Personal Information, including:

First Name *

Last Name *

School *

District *

Home Address *

City *

Zip Code *

Personal Email Address *

Phone *

Gender *

Ethnicity *

Academic Achievements, including:

Unweighted GPA (4.0 scale max) *

Weighted GPA (from transcript) *

SAT Score (if taken)

ACT Score (if taken)

College/University does not require standardized testing.

College/University Attending (if known)

Athletic Participation (This is for MPSSAA-sponsored sports only. Check all that apply. Please list Allied/Unified/Corollary sports in the next section.)

9th Grade Allied/Unified/Corollary Sports

10th Grade Allied/Unified/Corollary Sports

11th Grade Allied/Unified/Corollary Sports

12th Grade Allied/Unified/Corollary Sports

List your top non-athletic achievements, awards, or community contributions [i.e. Honor Societies, Music-related honors, Scouting honors (include rank)] and Non-Service Learning Fundraising/Charitable Activities with the approximate # of hours of involvement for each, if applicable. Do NOT list popularity contests, All-Conference/All-County/All-City/All-State/All-Metro designations, Honor Roll, Who’s Who, poster/essay type contests, and Service Learning activities required for graduation.

1. Honor Society Membership(s)

Hours

2. Leadership Positions Held

Hours

3. Music/Art/Drama Awards

Hours

4. Scouting Honors

Hours

5. Volunteer/Non-Profit Organization/Charity Work

Hours

6. Other Applicable Non-Athletic Recognition

Hours

7. Other Applicable Non-Athletic Community Contributions

Hours

Guidance Counselor information, including:

Guidance Counselor’s Name *

Guidance Counselor’s Email Address *

Guidance Counselor’s Phone *

Please list two references with phone and email. (At least one school-based reference, please.) *

By checking this box, I agree to the following terms: Completion of this application grants permission to the MPSSAA to receive a copy of each finalist’s transcript and SAT/ACT score verification. *

The MPSSAA reserves the right to withdraw this scholarship in the event that a selected student-athlete violates their school system’s Code of Conduct, does not graduate in good standing, or cannot be present at the Awards Luncheon to receive their scholarship.

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