
Keep Haralson Beautiful Scholarship Application Form
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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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