Jay Elmore Memorial Scholarship
Official Application
Please complete this application in its entirety. Include any attachments necessary, including a copy of your most recent high school transcript, and a letter of recommendation from at least one high school principal, guidance counselor, teacher, or church leader. All scholarship applicants must be seniors in high school. Please return the application no later than January 1, 2009 to:
Coca-Cola Jr. Tour
P.O. Box 381
Belden, MS 38826
STUDENT INFORMATION
Name: ____________________________________ Date of Birth: _________________
Address: ________________________________________________________________
________________________________________________________________
Phone: ________________________ Social Security #: __________________________
High School Information
High School Attended: ____________________________________________________
Address: ________________________________________________________________
________________________________________________________________
Latest Cumulative GPA: __________________ Rank/Class Size: __________________
ACT: __________ SAT: __________
College Information
College you hope to attend: _________________________________________________
Address: ________________________________________________________________
________________________________________________________________
Date entering as a full time student: __________________________________________
Probable Major: _________________________
EXTRA CURRICULAR ACTIVITIES:
Please list your extra curricular activities under the proper section. You may attach an additional sheet if more space is needed.
School Related Club and Activities:
Interscholastic Athletics:
Non-school Related Clubs and Activities:
Honors and Awards:
