2012 Scholarship Application

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SPECIAL NOTE: Parking for Gold Rush Days is managed and run by the Dahlonega Rotary Club.There is a $10 per vehicle fee to park in the North Georgia parking deck.

2012 Dahlonega Jaycees Scholarship Application

The Dahlonega Jaycees are giving away six (6) $1000.00 scholarships
to Lumpkin County citizens graduating in 2012.
Application deadline is May 1, 2012.

First Name (*)	Please let us know your name.
Middle Name
Last Name (*)
Email Address	Please let us know your email address.
Street Address (*)
City (*)
State (*)	Enter 2-letter state code
Zip Code (*)	Enter 5 digit zip code
Primary Phone Number (*)	Enter the phone number at which you can most easily be reached
Secondary Phone Number	Enter a second phone number at which you can be reached
Parent's Names (*)	Enter your parents' names
Have you or your parents ever been a member of the Dahlonega Jaycees? (*)	yesno

In what civic organizations or clubs have you participated?	List organizations separated by a comma.
In one paragraph, what are your educational goals? (*)
In one paragraph, explain why a Jaycees scholarship would benefit you? (*)
College, University, or Tech School to which you have been accepted: (*)	Enter the name of the school you will be attending.
	If you are selected for the scholarship, you must provide a letter of acceptance from the school you will be attending to the Dahlonega Jaycees Treasurer.
SAT Reading Score (*)
SAT Math Score (*)
SAT Writing Score (*)
High School Name (*)
High School GPA (*)
I validate that I am the person listed on this form and all information is true and accurate. (*)	yes Invalid Input
submit