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Keep Haralson Beautiful Scholarship Application Form

 

 

Applicant Information:

 

Full Name                                                                           _______________________________________________________________________

 

Mailbox Address                                                              _______________________________________________________________________

                                                                                                _______________________________________________________________________

 

Home Telephone Number                                           ___________________________________

Mobile Telephone Number                                         ___________________________________

Email Address                                                                   ___________________________________

 

Current School                                                                  _______________________________________________________________________

Homeroom Teacher                                                        ___________________________________

 

Birthdate                                                                             ___________________________________

 

Anticipated Graduation Date                                       _______________________________________________________________________

Anticipated College or Technical School                  _______________________________________________________________________

 

 

I have read and understand the annual scholarship requirements as presented by Keep Haralson Beautiful and agree to abide by those requirements                               [   ]  Yes     [   ] No

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Mailing Address:  PO Box 845, Tallapoosa, Georgia 30176            Phone: 678-378-3795