REPUBLICAN WOMEN OF BOSSIER
SCHOLARSHIP
A. PERSONAL DATA
NAME_______________________________________________________________________
ADDRESS____________________________________________________________________
CITY, STATE & ZIP____________________________________________________________
HOME PHONE______________________ CELL PHONE_______________________
SCHOOL ADDRESS____________________________________________________________
BIRTH
DATE_______________________________________________________
VOTER REGISTRATION (Parish, Ward & Pct.)____________________________________
LA STATE SENATOR______________________________________________________
LA STATE REPRESENTATIVE______________________________________________________
B. FAMILY AND FINANCIAL DATA
FATHER’S NAME______________________________________________________________
FATHER’S ADDRESS___________________________________________________________
OCCUPATION __________________________________ANNUAL INCOME_________________
MOTHER’S NAME_______________________________________________________________
MOTHER’S ADDRESS____________________________________________________________
OCCUPATION __________________________________ANNUAL INCOME__________________
If married, the following information must be provided:
HUSBAND’S NAME ________________________________________________________________
HUSBAND’S ADDRESS_____________________________________________________________
HUSBAND’S OCCUPATION ___________________________ANNUAL SALARY________________
ARE YOU EMPLOYED?________________ FULL TIME__________ PART TIME_______________
EMPLOYER’S NAME________________________________________________________________
ADDRESS__________________________________________________________________________
ANNUAL SALARY________________________________
FINANCIAL AID YOU ARE RECEIVING____________________________________________________
_____________________________________________________________________________________
______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
C. HIGH SCHOOL DATA
HIGH SCHOOL__________________________________________________________________________
GRADUATION DATE_______________________ GPA _______________CLASS RANK_________________
Attach a copy of transcript showing GPA and Class Rank. Attach copy of best ACT
score.
ACTIVITIES, ACHIEVEMENTS AND AWARDS__________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
__________________________________________________________________________________________
D. UNDERGRADUATE STUDIES
COLLEGE/UNIVERSITY______________________________________________________________________
ADDRESS___________________________________________________________________________________
ADVISOR ___________________________________________PHONE NO.______________________________
MAJOR ____________________________________________MINOR____________________________________
HOURS COMPLETED ___________________GPA____________________ SCALE (A=) ___________________
ACTIVITIES, ACHIEVEMENTS, AWARDS__________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
E. CIVIC INVOLVEMENT, INTERESTS OR HOBBIES
______________________________________________________________________________________________
______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
F. POLITICAL INVOLVEMENT
Provide any political experiences you may have had, i.e., campaigns you have
worked on, duties you performed, and
individuals to whom you reported. Be sure to include
the name of the candidate and the office the candidate sought.
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
G. FUTURE PLANS
On a separate page, describe your plans for the future, including plans for
after college.
SIGNATURE ______________________________________________DATE______________________________
MAIL COMPLETED APPLICATION TO:
Mrs. Anne Price
Republican Women of Bossier
104 Cambridge Circle
Bossier City LA 71111