Scholarship App

Name

First

Last

Birthday

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Are you a first generation college student? *

Do you live with a disability?

Parent or Guardian Name

First

Last

Parent or Guardian Email

Parent or Guardian Phone

Are you or a member of your family a CBH CO-OP Member? If so, please give the members name.

Highschool Name

Graduating Year

Cumulative GPA

Please provide details regarding extracurriculars you were involved with.

generation Please Name

Composite ACT Score

SAT Score (if taken)

Class Rank & Size of Class

Your essay should be at least 500 words and address your goals and community impact.

Paragraph Text

Please Upload you most recent academic transcript

Drag & Drop Files, Choose Files to Upload

Your Signature

Clear Signature

Date Signed