Gladys B. Leslie E. Smith, Jr. Memorial Scholarship
SCHOLARSHIP  APPLICATION
Return to the Guidance Office by April 20.

Please print or type.

Student’s Full Name: _______________________________________

Date of Birth: __________   Social Security #:____________________

Mailing Address: ___________________________________________________
          ___________________________________________________
Telephone: _______________________________________________

Name of parent or guardian: ________________________________________________________

Name of college, university, or trade school you plan to attend and its address:
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________

Date you expect to enter: (Month/Year)_____________________________________________

What is your intended major? ________________________________________________________

Briefly summarize your school and community activities. List organizations of which you are a member and offices held: (You may attach a resume instead.)

What scholarships/financial aid have you received that can be used at the college you will attend?

                                                                                               _____________________
Signature of Applicant