Name: ______________________________________________

Address: ______________________________________________

______________________________________________

Home Phone: ______________________________________________

Parents Name: ______________________________________________

Address: ______________________________________________

______________________________________________

High School GPA _______________ Class Rank ______________

SAT Scores ________________ ACT Scores __________________

School/College you have been accepted to: __________________________

Planned College Major __________________________________________

Please list your involvement in youth soccer. (May include recreation, high school, and travel. Playing, coaching and refereeing may be included)

Participation in Extracurricular Activities

Membership in organizations: ____________________________________

Offices and/or leadership positions held: ____________________________

Honors and Recognitions received: ________________________________

Other Activities: _______________________________________________

Memorial Scholarship

Criteria

***Applicant must have a background in youth soccer program. Minimum of three (3) years participation in recreation soccer program.

***Must be a senior at Upson Lee High School in good standing with GPA of 2.5 or higher.

***Applicant must be enrolled in an accredited college.

***Applicant must demonstrate participation in community service and extracurricular activities.

***Applicant must submit a one page typed autobiography.

***Applicant must submit a copy of high school transcript.

***Scholarship will be awarded on basis of community involvement and academic achievement.

***Scholarship payment will be made to institution.

Completed application, autobiography and transcript must be received by 5:00 pm on Wednesday, March 24, 2010 to Mindy Daniel at Civic Center.

Winner will be announced at Upson Lee High School Senior Honors Night.