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Scholarship Application

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First Name *

Last Name *

Your Email Address *

Your Phone Number

Birthday

Address Line 1

Address Line 2

Locations * Select The LocationUnited StatesNew YorkTampaMiamiAtlantaPhiladephiaNew JerseyDallasJacksonvilleLos AngelesCanadaMontrealTorontoCalgaryVancouverHalifaxOther

Other Location *

City

State ALAKASAZCACOCTDCDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip

Have you been accepted to an accredited college or vocational school? (if not, you can still apply) *

Yes

No

If yes, what is the name of the school?

Most recent GPA

What are some challenges you've faced over your lifetime and how have you overcome them? (100-500 words) *

What have you done to give back to your community? Examples include: volunteering with your youth group, picking up trash on your street, helping a friend in need. (100-500 words) * *

Little Nick scholarship recipients have big plans for their future. What do you hope to accomplish in your future and how will this scholarship help you to get there? (100-500 words) *

Are you planning to pay for your school next year ? *

Yes

No

What is your family's yearly household income ? * $200,000 or more$150,000 to $199,999$100,000 to $149,999$75,000 to $99,999$50,000 to $74,999$35,000 to $49,999$20,000 to $34,999Less than $20,000I have no idea

Are you involved in any government subsidized program ? *

Yes

No

Do you verify that all information given in this application is correct ? *

Yes

No

Do you agree to have your name used in media and announcements should you be selected for a scholarship ? *

Yes

No

If you are human, leave this field blank.

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