The E.L. Harrison Scholarship Fund Application Packet 2010 Application Enclosed Add Corporate Logo Here

E.L. Harrison Scholarship Application NAME:__________________________________ ADDRESS:______________________________ ________________________________________ TELEPHONE NUMBER:_________________________ ADDRESS: _____________________________ DATE OF BIRTH:_______________________________ SOC. SEC.#:____________________________________ FATHERS NAME:______________________________MOTHERS NAME:__________________ PLACE OF EMPLOYMENT: ________________________________ _______________________________________ HIGH SCHOOL PRESENTLY ATTENDING_________________________________________ GUIDANCE COUNSELORS NAME & TELEPHONE NUMBER_____________________________ CURRENT GRADE POINT AVERAGE:___________________ ARE YOU A MEMBER OF FIRST BAPTIST CHURCH?____________ WERE YOU BAPTIZED AT FIRST BAPTIST CHURCH?____________ WHEN WERE YOU BAPTIZED?___________________ HOW LONG HAVE YOU BEEN A MEMBER OF FIRST BAPTIST CHURCH?____________ DO YOU ATTEND SUNDAY SCHOOL?_________SINCE WHEN?____________ DO YOU PARTICIPATE IN ANY EXTRA CURRICULAR ACTIVITIES?_______ IF YES, TELL US WHAT THEY ARE:__________________________________________ ARE YOU A MEMBER OF ANY COMMUNITY OR CIVIC ORGANIZATIONS?_______ IF YES, TELL US WHAT THEY ARE?___________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____

Page 2 HAVE YOU PATICIPATED IN FIRST BAPTIST CHURCH AUXILARIES?______________ TELL US WHEN AND WHAT THEY WERE:________________________________________ _______________________________________________________________________________ _________________________________________________________________________________ WHICH AUXILIARES ARE YOU A MEMBER OF NOW?______________________________ _______________________________________________________________________________ HAVE YOU APPLIED TO INSTITUTIONS/COLLEGES? ___________ TELL US WHICH ONES:__________________________________________________________ _______________________________________________________________________________ ________________________________________________________________________________ HAVE YOU BEEN ACCEPTED TO AN INSTITUTION/COLLEGE?_____________________ __________________________________________________________________________________ ___________________________________________________________________________________ WHICH ONES? GIVE US THE COMPLETE ADDRESS: ___________________________________ ___________________________________________________________________________________ WHAT WILL BE YOUR MAJOR COURSE OF STUDY?______________________________________ ARE YOU EMPLOYED?_________TELL US WHERE:_______________________________________ ARE YOU INVOLVED IN VOLUNTEER WORK?_________________ TELL US WHERE:__________ _____________________________________________________________________________________ ************************* ALL INFORMATION IS THE PERSONAL CONFIDENTIAL PROPERTY OF THE E.L. HARRISON SCHOLARSHIP FUND ************************** A F F I D A V I T ALL INFORMATION GIVEN IS TRUE TO THE BEST OF MY KNOWLEDGE. THE E.L. HARRISON SCHOLARSHIP FUND COMMITTEE RESERVES THE RIGHT TO VERIFY ALL INFORMATION PROVIDED BY THE APPLICANT. ______________________ ________________________ STUDENTS SIGNATURE PARENTS SIGNATURE _______________________ _________________________ DATE