Scholarship Application First Name * Last Name * Your Email Address * Your Phone Number Birthday Address Line 1 Address Line 2 Locations * New York Tampa Miami Atlanta Philadephia New Jersey Other Other Location * City State AL AK AS AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY 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 $34,999 Less than $20,000 I 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 Δ
