Award Application

                                (click file, then print. when complete, hit your browsers back button to return to our site)

 

 

Applicant Name:                                                                                                                                                                 

                                                Last                                                        First                                                        M.I.

 

I.              Personal Information

               

Social Security No.                                                                              Birthdate (MO/YR)                                            

                                                                                                                                                                                                M           

                Telephone:            Res.                                                        Bus.                                                       Sex:         F             

 

                Address:                                                                                                City                                        Zip                        

 

II.            Education

 

                High School                                                                                                          Year Graduated                   

 

                College/University                                                                                                                                                              

                                                                (name of institution you plan to attend)

 

                Expected date of graduation (MO/YR)                                                                                                                            

 

                Degree sought                                                                                                      Major                                                   

 

III.           Essay                      (Attach one full-length page essay <type-written> to this form)

 

IV.           Membership

 

                Member in good standing with WHCC                                                                            Yes                         No

                Related to member in good standing                                                                                Yes                         No

 

                Name of member and relationship                                                                                                                    

 

                Former recipient of WHCC scholarship                                                                           Yes                         No

 

                Recipient of other scholarships                                                                                                                                        

                                  (Name of scholarships, i.e. KSBE, Hawaii Community Foundations, etc.)

 

V.            Ancestry

 

                Hawaiian                                                                                                                                Yes                         No

 

I hereby declare that I have completed all parts of this application, and to the best of my knowledge and belief, they are correct.  Further, I agree to the following:

                1. To provide additional information in support of my application at the request of WHCC.

2. To give WHCC the right to obtain the necessary information from the appropriate school, 

    college/university in order to determine satisfactory academic progress.

3. To the release of information taken from this application as deemed necessary at the sole discretion of      

                   WHCC.

 

Signature                                                                                                                                              Date                                       

                                                                (Rev-1/17/06)