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Bethel Park Republican Committee
Scholarship Award Program 2015
Purpose: To assist a Bethel Park student attending a four-year college with a Five Hundred Dollar
($500.00), one time, scholarship.
Eligibility: Bethel Park High School 2015 graduating class
Requirements: (1) Complete the application form in its entirety, sign and mail directly to the address
indicated no later than April 4, 2015. (2) Minimum GPA of 3.0 (an official copy of your High School
transcript must accompany your application form).
Deadline: April 4, 2015
Basic Information - Applicant
Last Name
First Name
M.I.
Address (C/S/Z)
Phone No.
Birthdate
Email Address
Date of Application
Basic Information – Parent/Guardian
Last Name
First Name
M.I.
Address (C/S/Z)
Relationship to Applicant
Phone No.
Email Address
Academic Information – Applicant
(Attach separate page if needed)
What field of study do you plan to pursue?
Name of postsecondary school(s) that you have applied to:
Schools that you have been accepted to (list in order of preference):
SAT (Math/Writing/Critical Reading):
ACT (English/Math/Reading/Science/Composite), if taken:
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Work Experience – Applicant
Describe your work experience over the past four years.
Employer/Position
From
To
Hrs. Worked
Paid?
(mm/yy)
(mm/yy)
(per week)
(Y/N)
Activities / Awards / Honors – Applicant
List all school activities in which you participated over the past four years (e.g., student government, sports, music, etc.).
List all community activities in which you participated without pay during the past four years (e.g., Boy/Girl Scouts, hospital
volunteer, Special Olympics, etc.)
Note all special awards, honors and offices received/held.
Attach separate page if needed.
High School Activity
Yrs. Of
Participation
Special Awards / Honors
Offices Held
Community Activity
Yrs. Of
Participation
Special Awards / Honors
Offices Held
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Essay – Applicant
Please write and attach a 500-word, or less, essay addressing the following topic:
“What the United States Constitution Means To Me”
The Bethel Park Republican Committee thanks you for your interest in applying for this scholarship.
Please send this application and all related items (transcript, essay, etc.) together, in one envelope, to:
The Bethel Park Republican Committee
P.O. Box 762
Bethel Park, PA 15102
DEADLINE: April 4, 2015
Please Sign:
Applicant Signature
Date
Parent/Guardian Signature
Date
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