Personal Information

Name *

Name

First Name

Last Name

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Phone

(###)

###

####

Email Address *

Date of Birth *

Gender

Male

Female

Prefer not to answer

Academic Information

Entering Gillette College as: *

Freshman

Sophomore

Non-traditional (21 or older)

Educational History *

Recent High School Attended:

Years Attended

Cumulative GPA

ACT/SAT Scores

Recent College Attended

Programs of Study/ Areas of Interest

Academic Honors, Awards, and Activities while in High School or College

Community Service Activities, Hobbies, and Extracurricular Activities

Financial Information

Personal Assistance Amount:

Other Scholarships Amount:

Grants Amount:

Must complete FASFA for Eligible Amount

Student Loan Amount:

Must complete FASFA for Eligible Amount

Other Financial Resources Amount:

Emergency Contact Information

Name(s) of Parent(s) or Legal Guardian(s) *

Contact Phone Number *

Address *

Relationship *

Email Address *

ATTENTION: *

I understand that proof of acceptance of current student enrollment from Gillette College is required prior to receipt of funding. I understand if I do not complete the full school year, my scholarship will be revoked and I will be responsible for all costs incurred.

Statement of Accuracy *

I hereby affirm all the above stated information provided by me is true and correct to the best of my knowledge. I hereby understand, if I am chosen as a scholarship winner, according to Gillette College's Enrollment policy, I must provide evidence of enrollment/registration at Gillette College before scholarship funds can be awarded.