SCHOLARSHIP APPLICATION

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Name of Current School:

School’s Telephone Number:

Address

Address Line 1

Address Line 2

City

State / Province / Region

Extra-Curricular Activities:

Please upload certified copies of past term reports from the Grade 6 academic year

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Allowed file type, docx, pdf

Please upload your PEP results here

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Allowed file type, docx, pdf

Please upload your Reference

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

At least one (1) reference- Principal, Pastor, Justice of the Pease or Superintendent of Police

Please submit a 3-5 min video on why you should be selected

Drag & Drop Files, Choose Files to Upload

Parent/Guardian’s Name

First

Last

Parent/Guardian’s Contact Number

Parent/Guardian’s Contact Number #2

Parent/Guardian’s Occupation

Parent/Guardian’s Email

Confirm Email

Are you a current employee of Bert’s Auto Parts?

Date Signed