Provide SSN if ID is not available.

(C, AA, H, A, AL, Other)

(If living with parents, must include parent(s) combined income)

(include scholastic awards, honors, leadership position, community service, and extracurricular activities)

Your career and education goals and how you plan to reach them. • Personal statement; Financial Resources, Single parent, etc. • Awards or honors received. • Community and/or school activities • Extenuating financial circumstance, if any.

State law requires that each student identify any relation to a current Board of Regent member. A student who is related to a current member of the governing board of that institution is prohibited from receiving scholarship funds unless the scholarship is awarded exclusively based on academic merit or is an athletic scholarship. It is a Class B misdemeanor to file a false statement.

By signing above, I acknowledge that I have read and understand the scholarship eligibility requirements found on and that all the information given on this application is true and correct. I understand the priority submission deadline is March 15.