Name

PARENT SIGNATURE

Approximate G.P.A.

Counselor’s Signature

THE GALENA WOMAN’S CLUB SCHOLARSHIP AWARD Senior Girls Only Date due in Guidance office - April 17, 2020 Last First Middle Home Address Street City State Zip List organizations/extracurricular activities to which you belong in High School and activities or employment outside school. (attach a sheet) List Honors & Awards received in and outside of school. (attach a sheet) Explain your future educational plans and career goals. (attach a sheet) Include any special circumstances in which you especially need a scholarship award. (attach a sheet) I hereby certify that the information given in this application is true and correct to the best of my knowledge. Date Applicant’s Signature