Online Scholarship Application

PERSONAL INFORMATION
Employee Name*			Current Position*
Student Name*			Student Date of Birth*
If other than an Employee, Relationship to Employee*
Address*
City*			State*	ZIP*
Phone*	Email*		US Citizen? YesNo	If No, are you a legal US Resident? YesNo
SCHOLARSHIP/EDUCATION INFORMATION
High School Students			College Students
High School Attending			College Attending
Anticipated Graduation Date			College Standing
College or University you will be attending		Accepted to school indicated? YesNo
Intended Major			College Major
High School GPA			College GPA
WORK EXPERIENCE: List jobs held during the past three years, starting with the most recent.
Employer	Nature of Work	From Mo/Yr	To Mo/Yr	Avg Hrs/Wk	Amount Earned


COMMUNITY SERVICE: List your community service activities during the past three years, starting at the most recent.
Organization	Specific Nature of Service		From Mo/Yr	To Mo/Yr	Total Hours



HONORS AND AWARDS: List scholastic awards and civic honors you have received. Please list those that best demonstrate your abilities. Please state who granted the award, the nature of the award, and what you did to earn the award. Please do not abbreviate names of awards, as we may not understand the abbreviations.
1.			3.
2.			4.
EXTRACURRICULAR ACTIVITIES: List extracurricular activities. List extracurricular activities.
Activity 1			Activity 2
ADDITIONAL QUESTIONS:
What are your goals?
What has attracted you to the career you are pursuing?
How would this scholarship assist you in accomplishing your goals?
Please list any additional information you would like to share with the scholarship committee that may influence their decision on awarding you a scholarship.
Applicant Essay: Please upload an essay of no more than 750 words on a topic of your choice. File must be of type .doc, .docx, .pdf or .txt
File Size: 5000KB Maximum File Types: .docx .doc .pdf .txt
REFERENCES: Two letters of reference are required with this application. References should be from educators, civic leaders, employers, or other members of the community who know you well enough to speak on your behalf. Family members are not acceptable references.
Reference Name			Position
Company Name/School			Phone
Reference Letter 1: Please upload reference letter 1. File must be of type .jpg, .gif, .png, or .pdf. File Size: 5000KB Maximum File Types: .jpg .gif .png .pdf
Reference Name			Position
Company Name/School			Phone
Reference Letter 2: Please upload reference letter 2. File must be of type .jpg, .gif, .png, or .pdf. File Size: 5000KB Maximum File Types: .jpg .gif .png .pdf
APPLICANT’S SIGNATURE/CERTIFICATION: By my signature below, I certify that I meet the requirements of this scholarship and the information in this application is true and complete to the best of my knowledge. I agree that the application and all attachments may be used for the purpose of evaluation and selection by the Jacksons Scholarship Committee.
Applicant Signature*				Applicant Date*
JACKSONS COMPANY EMPLOYEE SIGNATURE: By my signature below, I certify that the above applicant is a child of mine. I understand that if the scholarship is awarded to and accepted by my child I will be taxed on the gross amount of the scholarship.
Sponsor Signature*				Sponsor Date*
Submit
* Required