Application | Mediacom World Class

Section 1 – Personal Information

First Name

Last Name

Address

Address 1

City

State / Province

ZIP / Postal Code

Phone Number

Email Address

Section 2 – Academic Information

Current School

School Counselor First Name

School Counselor Last Name

School Counselor Email Address

School Address

Address 1

City

State

ZIP / Postal Code

Phone Number

Anticipated Graduation Date

Date

Transcript Upload

File uploads are limited to Word docs, PDFs, and text files under 10MB.

Section 3 – Essay

Essay

As part of this application, we ask that you write and attach an original essay of no more than 500 words. The essay prompts found on the homepage may be used to describe or reflect on events which have led to your personal growth or your desire to use your skills to help others. Be creative! A separate list of honors, awards and accomplishments that you have achieved may be included in the next section.

500 words left

Section 4 – Community Involvement

Community Involvement

Please list the community events and organizations in which you participate. Include any employment.

Section 5 - References

References

Please add at least one reference. This may be from an educator or a member of your community.

Section 6 – Electronic Signature

Signature

TO BE READ AND SIGNED BY SCHOLARSHIP APPLICANT I hereby declare that all information contained in this application is true to the best of my knowledge. The essay is my own work. I also agree to abide by all scholarship policies as detailed in this document