Application Form 

Alfred G. and Elma M. Milotte Scholarship
Please type in your information, print out the completed application and mail it in with the other materials required on the Apply page.

A. Personal Information:
Full Name:
Permanent Street Address:
City and State:
Zip Code:
Birth Date:
Social Security Number:
College student I.D. # (if applicable)
Current grade level:
Cumulative grade point average:
Resident of Washington since:
High school or G.E.D. graduation date:
Current school:
School you plan to attend:

B. Brief Essays - Please respond to theses questions

1. Discuss the work you submitted. 

  • When was it done? 

  • How did you choose your subject matter?

  • Why did you do it?

2. How have you shared this work with others? Who was your audience?

3. How does this interest relate to your educational and career goals?

4. How will you continue this work in the future?

5. How would you use the scholarship funds, if awarded?

C.   Agreement

I give my permission for the information contained in this application to be reviewed by the Selection Committee and Trustee. I also grant permission to the Trustee and Selection Committee to obtain all other information necessary for determination of my eligibility for this scholarship. I attest that all information is true and accurate to the best of my knowledge and represents my own work.

________________________________________ ______________
Applicant's Signature Date 


Parent/Guardian Signature (if applicant is under 18) Date 


Please Print this completed Application and refer to the Apply page.


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Trustee for the Alfred G. and Elma M. Milotte Scholarship Fund