Application for Garrity-Laird Scholarship. Please type or print in ink.

Name_______________________________________________	Date of Birth_______________
Address_____________________________________________	Phone_____________________
Email Address________________________________________
Father’s Name________________________________	Occupation_________________________
Mother’s Name_______________________________	Occupation_________________________
Name and location of the school that you wish to attend ____________________________________
__________________________________________________________________________________
Intended course of study or major_______________________________________________________
Have you applied?_____________________Have you been accepted?__________________________
Current graduation status (e.g. Senior, class of 20__)    _____________________________________
List your employment record beginning with your most recent job:
Place_______________________________________________                 Date__________________
Place_______________________________________________                 Date__________________
In the space below list theater shows, and other art activities you have been a part of. Please include any of our organization’s events you have participated in at the beginning of the list.
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
In the space below list extracurricular school, community, and church activities during high school (include offices held):
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
In the space below write a brief autobiography. This could include information about your career goals,  and any other information that you feel would help in scholarship selection.
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________

Applicant’s Signature___________________________________________________


Parent/Guardian’s Signature______________________________________________

……………………………………………………………………………………………………………
Do not write below this line
Class Rank___/___     G.P.A.____/4.00
Test Scores:                  P.S.A.T.   Verbal____  Math _____
                                     S.A.T.      Verbal____  Math_____

Counselor’s Signature___________________________________________