Legacy Scholarship Application

Section 1. Application Information

* First Name

* Last Name

* Street Address

Address Line 2

* City

* State

* ZIP Code

* Home Phone

Cell Phone

* College/University Attending

* Major

* Classification

Section 2. Member Relative Information

* Name of ATA Member

* Club/Company/Employer

* Street Address

Address Line 2

* City

* State

* ZIP Code

* Email

* Relationship to Applicant

Parent
Grandparent
Living
Deceased

* Member Since

* Current Classification

Section 3. Applicant’s Academic and Community Service History

Applicant’s Academic and Community Service History

* Name of Institution

* Location (City, State)

* Dates Attended

* Grade Point Scale

* Dates of Graduation

List any academic distinctions and honors you have received in high school or college

List school or college activities in which you have participated as well as any office you held in any of these organizations (athletics, clubs, school paper, fine arts, etc.)

List your activities outside school or college as well as any office you held in any of these organizations (clubs, organizations, community, etc.)

List employment you have held since entering high school

List any other scholarships awarded

Scholarship

Sponsor

Date

Amount

* Do you qualify for in-state tuition?

Yes
No

* Please give the names of your local community and school newspapers

Section 4. Certification

I certify that the above information is true and correct to the best of my knowledge. A transcript of your grades must be submitted with this application.

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