COMMUNITY COLLEGE SCHOLARSHIP

1. Name

First Name *This question is required.

Middle Name

Last Name *This question is required.

2. Contact Information

Telephone # *This question is required.

Email *This question is required. This question requires a valid email address.

3. Present Address

Street *This question is required.

City *This question is required.

State *This question is required.

ZIP *This question is required.

4. Permanent Address

Street *This question is required.

City *This question is required.

State *This question is required.

ZIP *This question is required.

Birth Date *This question is required.

Place Of Birth *This question is required.

Gender *This question is required.

Marital Status *This question is required.

Dependent Children *This question is required. This question requires a valid number format.

7. How did you hear about the Joseph Shinoda Memorial Scholarship program? *This question is required.

College you are now attending *This question is required.

Anticipated graduation date *This question is required.

Degree sought *This question is required.

Major *This question is required.

Area of concentration *This question is required.

Present Student Status *This question is required.

Cumulative GPA (You will be required to submit transcript of grades with this application - you can upload copy in last section, before submitting.) *This question is required. This question requires a valid number format.

Number of years attending this college *This question is required. This question requires a valid number format.

9. *This question is required.

Are you planning to continue your education at a four-year college? *This question is required.

What will be your choice of major? *This question is required.

10. List extracurricular college activities including clubs and organizations to which you belong *This question is required.

11. List any academic honors, scholarships, prizes or special recognition you have received in school or from an outside organization *This question is required.

12. Have you had any experience in the florist or floriculture industry? *This question is required.

Please describe experience

Dates *This question is required.

Organization *This question is required.

City *This question is required.

State *This question is required.

Activities *This question is required.

Dates

Organization

City

State

Activities

13. Are you presently employed? *This question is required.

Please give name and address of employer, hours worked per week and brief description of duties:

Employer's Name *This question is required.

Employer's Address *This question is required.

Hours Worked Per Week *This question is required. This question requires a valid number format.

Duties *This question is required.

COMMUNITY COLLEGE SCHOLARSHIP

APPLICATION