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Scholarship Application Form

  • First Name:
  • Last Name:
  • First name you prefer to be called (if different):
  • Social Security Number:
  • Date of Birth:
  • Home Address
  • Street:
  • City:
  • Zip:
  • County:
  • Cell phone:
  • Email address:
  • Name of parent(s) or guardian(s) with whom you live:
  • Parent’s cell phone:
  • Parent’s email address:
  • Do you plan to work while at college?
  • Full time?
  • Part time?
  • Work/study program?
  • Name of your High School:
  • Principal:
  • Address
  • Street:
  • City:
  • Zip:
  • Senior Counselor’s Name:
  • Senior Counselor’s Email:
  • GPA:
  • Class Rank:
  • Class Size:
  • ACT Score:
  • Academic Clubs:
  • Academic Awards:
  • High School Offices Held:
  • Community Activities:
  • Golf and Other Athletics
  • Average Golf Score or Handicap?
  • Where do you plan to attend college?
  • Have you applied for admission?
  • Have you been accepted?
  • What field of study do you plan to pursue?
  • If selected, I authorize the Birmingham Golf Association to use my name and
    photograph, and I agree not to hold Birmingham Golf Association liable for any such use.
  • Signature of Applicant
  • Signature of Parent/Guardian