Application Form

First name

Last name

Phone

Birthday

Address

Are you a resident of North Carolina?

High School Name

Expected Graduation Date

Current GPA

Are you receiving a full scholarship? (Applicants receiving full scholarships are not eligible.)

Intended College/University/Program

Type of Institution

Intended Field of Study

Academic Honors / Awards

List leadership roles

Community service involvement

Have you participated in Carolina Strive programs? If yes, describe your involvement

Describe how you demonstrate leadership, integrity, and community involvement. How will this scholarship help you achieve your educational and career goals?

Recommendations (atleast 3 person) Please put the Recommender Name and your relationship with them

Transcript Record

3 Recommendation Letters

School Enrollment Document

Two Forms of ID / Proof of Residence

I certify that all information provided is true and complete.

I understand incomplete applications will not be considered.