Name: _____________________________________________________________________________________
Address: ___________________________________________________________________________________
Phone: _________________________________________ Cell: ______________________________________
Parent/Guardian Name: ______________________________________________________________________
High School Graduating from in 2010: ___________________________________________________________
Cumulative Grade Point Average (after 7 semesters): ______________________________________________
College you will be attending in 2010:___________________________________________________________
Address: __________________________________________________________________________________
(if you have not arrived at a final decision or have not yet received final acceptance from the school of your choice, please state that on
this application. The check will be held until you receive confirmation).
List High School Sports / Activities / Clubs: ______________________________________________________
__________________________________________________________________________________________
List activities / clubs / memberships outside of school: _____________________________________________
__________________________________________________________________________________________
List ten ways a high school senior can make Palos Hills a better place to live:
1.________________________________________________________________________________________
2. ________________________________________________________________________________________
3. ________________________________________________________________________________________
4. ________________________________________________________________________________________
5. ________________________________________________________________________________________
6. ________________________________________________________________________________________
7. ________________________________________________________________________________________
8. ________________________________________________________________________________________
9. ________________________________________________________________________________________
10. _______________________________________________________________________________________
On a separate sheet of paper, expound on one of the above ideas in 300 words or less.
I agree to allow my son / daughter to apply for the 2nd Ward Scholarship and I fully understand the details of the
scholarship program. I also agree to allow the 2nd Ward Aldermen to use my son / daughters name and photo in
any publicity used by the Aldermen or the City of Palos Hills in relation to said scholarship.
____________________________________________________________ __________________________
Signature Parent/Guardian Date
