Scholarship Program Application

Name:
Address:
City/State/Zip:
Telephone No.:
E-mail:
Applicant Date of Birth:
BECi Member Name:
BECi Account Number:
Relationship to Applicant:
Most Recent Grade Point Average (GPA):
This is a High School GPA College GPA
High School Attended:
Year of High School Graduation:
University you plan to attend or attending at present:
That institution is on the Semester System Quarter System
Number of hours you are planning to take per Semester/Quarter:

I have read and I understand all of the requirements and I agree that any rights to said scholarship will be forfeited, should any of the requirements fail to be met.