COA Scholarship Application

Applicant First Name:

Applicant Last Name:

Address:

Email:

Phone:

Parent(s) or Guardian(s) Full Name:

Current High School or College Attending:

High School Attendance Record (Days Present/Absent):

Name of post-secondary college, university, trade school, vocational program, etc. for which you are requesting aid:

Major/Area of Study:

Student Status:

Accepted

Pending

Currently Enrolled

Describe the school/community activity in which you have been most involved during your school years. Explain how long you have been involved, how much time you have spent participating, and why you decided to devote your time to this activity:

Describe your future aspirations:

Describe how your parent(s)’ involvement in officiating high school athletics has influenced you:

Applicants must include a copy of their most recent high school or college transcript. The transcript should include the following information: a record of grades, class rank, and College Board scores (if applicable):

By submitting this application, I declare that the information on this form, to the best of my knowledge, is true, correct, and complete. I understand that the Selection Committee may request additional information by means of a personal interview with the applicant. I understand that incomplete or false information could result in disqualification.

Applicant Signature

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