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|Notes to Candidates for Scholarship: You must submit your materials to the Gadsden County High School Senior Counselor . All sections of application should |

|be filled out properly, in addition to the essay question. Contact info will be detailed at the end of application. Please submit all documents for |

|scholarship by May 6, 2019. Selected candidate will be rewarded in the amount of $1000.00 for his/ her 1st year of higher learning with confirmed |

|transcripts in both fall/spring semesters of scholastic year. |

|I, | |have read and understand the conditions of the "G20/20” Scholarship Scholarship as explainedddd |

|that’s explained in the current Notes to Candidates for Scholarship box. I affirm that I plan to pursue an education of higher learning as defined in these |

|documents provided. I give permission to officials of my institution to release transcripts of my academic record and other information requested for |

|consideration in the Graham’s 20/20 program. I understand that this application will be available only to qualified people who need to see it in the course |

|of their duties. I affirm that all of this application, including the policy proposal, is my own work for formally cited from other sources. I affirm the |

|information contained herein is true and accurate to the best of my knowledge and belief. |

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|Signature | |Date ____________ | |

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|Legal name in full | | | | |

|(Print/Type) | | | | |

| |Last Name |First Name |Middle Name | |

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|Permanent residence | |

| |Number, Street, and Apartment Number |

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| |City |State |ZIP |

|School Address | |

| |Number, Street, and Apartment Number |

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| |City (if studying abroad, add country) |State |ZIP |

|How is permanent residence established? |Home telephone |( ) |

|(At least two must apply.) | | |

|Home address for school registration | | |

|Place of registration to vote | | |

|Family’s primary residence | | |

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| |School telephone |( ) |

| |(if different) | |

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| |E-mail address | |

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| Other: | |Date of birth | |Age | |

| | |Month/Day/Year | |

|(Check one) I am a U.S. citizen U.S. national Resident alien expecting citizenship by the date of award |

|Will you be studying attending higher learning at a University/ Collage, and/or Technical Institution? Yes No |

|(If yes) Where? | |Please include acceptance letter. |

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|Name of nominating institution | |

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|Current cumulative GPA | |on a scale of | | |

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|Number of high school credits earned date | |Total number of credits required for graduation | |

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|Expected date to receive high school diploma | |Technical certification receive | |

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|List the High school from which you graduated and all higher education institutions attended. Include dual enrollment, study-abroad, exchange programs and|

|technical certification programs (up to six). |

|School |Location |Dates Attended |

|List high school activities (student government, sports, publications, school-sponsored community service programs, student-faculty committees, arts, |

|music, etc.). List in descending order of significance. You will have space for up to 10 high school activities. |

|High Activity |Dates |Offices |

|List public service and community activities (homeless services, environmental protection/conservation, advocacy activities, work with religious |

|organizations, etc.). Do not repeat items listed previously. List in descending order of significance. You will have space to list six. # of |

|Weeks |

|Activity |Role | Dates |Active |

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| |Application – 2 of 5 | | |

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|Name | | |

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|List government activities (internships with government agencies, partisan political activities, ROTC/military, municipal boards | |

|and commissions). List student government under Item 2. | |

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| |# of Weeks |

| |Active |

|Activity |Role |Dates | |

|List part-time and full-time jobs and nongovernment internships up to high school graduation. |

| | | |Average # of |

|Type of Work |Employer |Dates |Hours/Week |

|List awards, scholarships, publications or special recognitions you have received. List in descending order of significance. |

|Describe one specific example of your leadership. (The writer of your letter of recommendation re: Leadership Abilities and Potential must confirm this |

|experience.) |

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|Approved for use through 08/03 |

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|Describe a recent particularly satisfying public service activity (do not repeat experience described in 7). |

|9. Describe the problem or needs of society you want to address when you enter public service. (If possible, use statistical data to define the magnitude |

|of the problem.) |

|10. What are the three most significant courses you have taken in preparation for your career? |

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|Describe the graduate education program you intend to pursue if you receive a Graham’s 20/20 Scholarship. |

|What do you hope to do and what position do you hope to have upon completing your graduate studies? |

|What do you hope to do and what position do you hope to have five to seven years later? |

|What additional personal information do you wish to share with the Graham’s 20/20 Scholarship Foundation? |

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|Essay Question (At Least 250 Words): If you had the authority to change your school in a positive way, what specific changes would you make? (Please use |

|additional sheet of paper, type and double space, if needed) |

For further information please contact Shaquille O’Neal Graham at (850) 980-2228 or via email at s.oneal.graham@

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