PHHS Scholarship Recipient Information Form

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We are requesting for all seniors to complete this form no later than Friday, May 18, 2018. This information will be utilized during the Scholarship Awards Ceremony if you will be receiving an award. We want to ensure that we announce the correct information. Failure to complete this form may jeopardize the crediting of your award. Please contact Mrs. Edwards, in the Career Counseling Center or at spedwards@hcps.us, with any questions. Thank you!

Email *

First Name (use legal name) *

Last Name *

Address (include zipcode) *

Press ENTER for a new line for the address.

Email Address *

Phone Number *

Last 4 digits of your Social Security Number *

XXX-XX-___ ___ ___ ___

Full Name of College or Technical School *

All scholarship awards will be mailed to your college. Checks cannot be made out to individuals.

College/Technical School Student Accounts Mailing Address *

Address MUST be complete. This is where we send your check. Press ENTER for a new line for the address.

College/Technical School Student ID # *

College/Technical School Major *

This information will be announced at the Scholarship Awards Ceremony.

Student Signature *

This will serve as your official signature.

Date *

YYYY

Parent Signature (If student is under 18 years of age.)

This will serve as your official signature.

Date

YYYY

Submit

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