High School Scholarship Application

High School Blood Drive Scholarship Application Form

Student's High School:(Required)

High School Address:(Required)

Street Address Address Line 2 City State ZIP Code

High School Principal's Name:(Required)

First Last

Nominator Name:(Required)

First Last

Nominator Phone:(Required)

Nominator Email:(Required)

Blood Drive Faculty Advisor:(Required)

First Last

# of Students in Junior Class:

# of Students in Senior Class:

Student's Name:(Required)

First Last

Student's Address:(Required)

Street Address Address Line 2 City State ZIP Code

Student's Phone Number:(Required)

Name of College/University Student is Attending:(Required)

University Mailing Address:(Required)

Street Address Address Line 2 City State ZIP Code

Why are you nominating this student?(Required)

When is your high school's Senior Awards Program? (Include date, time, location):(Required)

Will you permit a Community Blood Center representative to attend your awards program to present the scholarship award?(Required)

Yes

If yes, what time should our representative arrive?

Contact person at awards program:(Required)

Phone

This field is for validation purposes and should be left unchanged.