Return to Mrs. Lisa Toldi in the CHS Guidance Office by Wednesday, April 11, 2018….Thanks!

Eligibility: Please attach:

n 3.0 GPA n Resume (include honors and activities)

n 25 or above ACT n Transcript (unofficial is acceptable)

n Enrolling in four-year college n College acceptance letter

n Evidence of school and community involvement

Name: _______________________________________________________________________________

Address: _____________________________________________________________________________

City: __________________________________ State: _____________________ Zip: _______________

Home Phone: (_____) _______-_________ Cell: (_____) _______-_________

Father/Guardian’s Name: _______________________________________________________________

Occupation: __________________________________________________________________________

Mother/Guardian’s Name: ______________________________________________________________

Occupation: __________________________________________________________________________

College/University you plan to attend: _____________________________________________________

Academic Average: _____________________________ GPA: ________ Class Rank: ______________

ACT (composite): __________________ SAT (verbal): __________________ (math): _______________

I, hereby, authorize the Twentieth Century Club to review my high school records.

___________________________________________________ ____/_____/18 Student Signature Date

Mary Louise Scholarship Application *** 2017-2018 *** $1,000

Application Deadline – Wednesday, April 11, 2018