General Application Form

To begin the application process, first complete this General Application Form.

TIP: Need help with the Expenses section? Use this handy worksheet to help you prepare.

NOTE: You must answer every question to successfully submit this form. If a question does not apply, please type “NA” (Not Applicable) or “TBD” (To Be Decided).

Applicant Name*
First Middle Last
Birthdate*
MM slash DD slash YYYY
Email*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
How did you find us?*
- Social Media
- Word of Mouth
- Referral
- Event/Networking
- Current/Past Recipient
- Current/Past Supporter
- Internet Search/Website
- E-Blast/E-News
- Direct Mail
- Other
Mother or Female Guardian*
First Last
Mother or Female Guardian Email*
Mother or Female Guardian Phone*
Address (if different than applicant)*
Street Address Address Line 2 City State ZIP Code
Mother or Female Guardian Occupation*
Mother or Female Guardian Employer*
Father or Male Guardian*
First Last
Father or Male Guardian Email*
Father or Male Guardian Phone*
Address (if different than applicant)*
Street Address Address Line 2 City State ZIP Code
Father or Male Guardian Occupation*
Father or Male Guardian Employer*
Siblings*
Names and ages of all children in the family. Include yourself.
Siblings — College*
Have any siblings attended college? If so, please list their name(s) and school(s).
Siblings — Graduation*
Have any siblings graduated from college? If so, please list their name(s) and year of graduation.
SCHOOLING
Are you currently in high school?*
- Yes
- No
Current High School*
If yes, list the name, street address, and phone number of high school you currently attend.
Have you attended any other high schools?*
- Yes
- No
Other High Schools*
If yes, list the school names, city, and years of attendance.
College Start Semester*
If you are currently in high school, what semester do you plan to begin college?
- Fall
- Spring
College Start Year*
College Plans*
What college, university, or vocational school do you plan to attend?
College Acceptance*
Have you been accepted to that school?
- Yes
- No
College Acceptance Expectation*
Formal acceptance is a requirement for completion of this scholarship application process. If you have not yet been accepted, when do you anticipate hearing from the school?
Are you currently in college or vocational school?*
- Yes
- No
College or Vocational School*
If yes, list the name, street address, and phone number of school you attend.
College Current Year*
If you currently attend college, what year are you in?
What is your major?*
If you don’t know yet, it’s all right to say that.
When do you anticipate graduating?*
Have you attended any other colleges or vocational schools?*
- Yes
- No
Other College or Vocational Schools*
If yes, list the names, addresses, and years of attendance.
List the courses you plan to take for this coming semester.*
ESTIMATED FINANCES PER SEMESTER
Name of school*
Tuition and fees per semester*
Estimated cost of books and materials per semester*
Where will you be living?*
- Parents’/guardians’ home
- University housing
- Apartment/off-campus housing
If not living at home, estimated cost of room and board per semester*
Other expenses (description and estimate)*
TOTAL estimated expenses per semester*
Your sources of income for the semester*
List all scholarships, grants, and loans, whether from family, friends, or other organizations. List any financial aid from your school. List any employment during the semester, including on-campus work/study programs. List any “college gifts” from family or friends. List the source and amount of each for this coming semester.
COMMUNITY INVOLVEMENT
Do you currently participate in a community institution?*
- Yes
- No
If yes, list the name, address, and phone number of the organization(s).*
Does this institution or organization have a leader?*
- Yes
- No
If yes, list the name and phone number of that person.*
APPLICATION SUBMISSION CONSENT
MEDIA RELEASE AND STATEMENT OF COOPERATION*
I agree to allow the Scott Murray Scholarship Fund to use my photograph or video recording in their public promotional materials. I understand I will receive no financial remuneration for that use. I agree to cooperate with the Fund, respond to their inquiries, and be interviewed for their promotional purposes. I understand that by doing so, I am “paying it forward”—helping the organization to inform others about their work and raise funds for future scholarships.
I agree.
PARENT OR GUARDIAN CONSENT*
If I am younger than 18 years old at the time of submission of this application, I have discussed this media release with the following parent or guardian, and s/he gives permission for the Scott Murray Scholarship Fund to use my photograph or video recording for promotional purposes.
This is a true statement.
Name of Parent or Guardian Consenting*
First Last
STATEMENT OF CERTIFICATION*
I certify that the information provided on this application is true to the best of my knowledge at the time of submission. I agree that the decision of the Selection Committee is final. I also understand that should any of the above information be discovered to be false, or if I fail to maintain a 2.5 GPA, the Scott Murray Scholarship Fund reserves the right to stop payment on the scholarship award.
I certify.
EMAIL CONSENT*
Your email is required to receive a reply. By checking this box and submitting your information, you are granting us permission to email you. You may unsubscribe at any time.
I consent to receive emails.
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Name
This field is for validation purposes and should be left unchanged.

Once you submit this form and we confirm receipt in an email, you will use the Cover Letter Form to accompany each of the subsequent documents you are required to submit. Do not send any additional documentation until we confirm receipt of your General Application Form.

If you have any questions about any aspect of the application process, please contact us.

CONTACT

General Application Form

To begin the application process, first complete this General Application Form.

SCHOOLING

ESTIMATED FINANCES PER SEMESTER

COMMUNITY INVOLVEMENT

APPLICATION SUBMISSION CONSENT

If you have any questions about any aspect of the application process, please contact us.