Phillips Scholarship Fund
P. O. Box 20111
Sugar Land, TX 77496

E-mail: info@phillipsscholarshipfund.com
Web Site: www.phillipsscholarshipfund.com

Your Name (required)

Your Address (required)

Your Email(required)

Contact Phone Number (required)

Your High School (required)

Your Grade Point Average (required)

Date of Birth (required)

Sex (required)

Are you a U.S. Citizen? (required)
YesNo

If not, do you have a Student/Permanent Resident Visa?
YesNo

Visa Number

Are you a resident of College Park, GA or Missouri City, TX? (required)
YesNo

List any honors, distinctions and scholarships that you have received, attach more pages if necessary.

List your extracurricular activities and organizational involvement, attach more pages if necessary.

APPLICANT’S STATEMENT

In submitting this application, I hereby certify that:

1. I have met ALL requirements as outlined and acknowledge that misrepresentation of the information presented may be grounds to rescind the scholarship award. I also agree to inform the scholarship committee of any significant changes to that information.

2. I will use the proceeds of the scholarship received for the payment of tuition, required fees, room and board, and/or required materials only.

3. If I am awarded a scholarship, I will provide satisfactory evidence, as required by The Phillips Scholarship Fund, of my fulltime enrollment during the period for which the scholarship is awarded.

4. I understand that submission of this application constitutes permission to use my name and/or photograph for promotional purposes in all of The Phillips Scholarship Fund publications.

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