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Scholarship Form
Step 1: Personal Data
Date
First Name
Middle Name
Last Name
Permanent Address
Address
Suite/Apt
City
State
select one
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
How is Permanent Residence Established?
Home address
Place of registration to vote
Family's primary residence
Other
Cell Phone
Home Phone
Email
Date Of Birth
I am a
US Citizen
US National
Resident alien expecting citizenship by the date of award
Have you previously attended college?
Yes
No
Name and address of college
Grade Point Average
Major
Number of College Credits Earned to Date
Step 2: Professional Data
1. List your last three jobs.
Employer #1
Date Started
Position
Hourly Wage
Employer #2
Date Started
Position
Hourly Wage
Employer #3
Date Started
Position
Hourly Wage
2. List awards, scholarships, publications or special recognitions you have received. List in descending order of significance.
3. Describe one specific example of your leadership.
4. Scholarship Video Essay - Create a 4-6 minute video essay, taking into consideration the background and the criteria of this scholarship, explaining why are you the best candidate to receive it. You may want to discuss your past academic or personal achievements, leadership skills, community and school involvement, or obstacles you have overcome. This essay must not exceed 6 minutes. PLEASE upload your video here or email your essay admin@ppr-corp.com
5. What are the three most significant courses you have taken in preparation for your career?
6. What additional personal information do you wish to share with the Jasmine L Winston Educational Foundation Scholarship Committee?
How did you hear about this scholarship?
Website
Friend
School
Social Media
College Fair
Email
Other
eSignature
Today's Date
Send
