Dawn Busters Kiwanis
Scholarship Application Form
Name
*
First Name
Last Name
E-mail
*
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Birth Date
*
-
Month
-
Day
Year
Date
Sex
*
Female
Male
Mother's Name
*
First Name
Last Name
Father's Name
*
First Name
Last Name
School
*
Select School
East Jefferson
Ecole Classique
Grace King
Kenner Discovery
Mount Carmel
Ridgewood Prep
Southeast Louisiana Youth Council
GPA
*
Years in Key Club
*
Describe your involvement with Key Club
*
Service Hours
Service Hours at Dawn Busters Activities
*
Crescent City Classic
Golf Tournament
Lafreniere Easter Egg Hunt
Lafreniere Trunk/Treat
Turkey Fry
Other
Total
Freshman Year
Sophomore Year
Junior Year
Senior Year
Names of the Other Dawn Busters Activities
Other Activities with Dawn Busters
Service Hours at Key Club Activities
*
Service Hours
Freshman Year
Sophomore Year
Junior Year
Senior Year
Total
Service Hours at Non-Key Club Activities
*
Service Hours
Freshman Year
Sophomore Year
Junior Year
Senior Year
Total
Total Hours at Dawn Busters Activities
(Automatically Filled)
Total Hours at Key Club Activities
(Automatically Filled)
Total Hours at Non-Key Club Activities
(Automatically Filled)
Total Service Hours
(Automatically Filled)
What College/Institution do you plan to attend?
*
What major(s) are you considering?
*
What additional information about yourself would you like to share with the selection committee?
Application Date
*
-
Month
-
Day
Year
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Submit
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