Professional Documents
Culture Documents
Phone: ( ) ______________--__________
Fax: ( ) ______________--__________
Email: ________________________________
Name: __________________________________________________________________________________
Last (Family Name) First MI Maiden
High School
Name of High School: From:(Mo./Yr) To:(Mo/Yr) Graduation date
________________________________________________________________________________________________
________________________________________________________________________________________________
COLLEGE/UNIVERSITY ATTENDED
Name of School: From(Mo/Yr) To:(mo/yr) Graduation Date
__________________________________________________________________________________________________
__________________________________________________________________________________________________
V. PROGRAM INFORMATION
Which program are you applying for ? (check one) ASCC(AA) Undergraduate (BA)
Cumulative Grade Point Average : ____________ High School __________ ___ ASCC
Name and Address of Colleges and Universities :
1._______________________________________________________________________________________________
2________________________________________________________________________________________________
3.________________________________________________________________________________________________
Intended Major:___________________________________________________________________________________
I HEREBY CERTIFY THAT THE INFORMATION GIVEN IN THIS APPLICATION IS COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE .
I AGREE AND ACCEPT THAT ANY FALSE STATEMENT(S)OR MISREPRESENTATION MAY RESULT IN DISQUALIFICATION AND/OR
INELIGIBILITY TO RECIEVE THE SCHOLARSHIPAWARD.
RECIEPIENTS OF AMERICAN SAMOA GOVERNMENT (ASG) SCHOLARSHIP AWARDS ARE INELIGIBLE TO RECEIVE MCDONALD'S
SCHOLARSHIP AWARD.
I ACKNOWLEDGE THE APPLICATION IS SPECIFICALLY LIMITED TO THE PROVISION OF FINANCIAL ASSISTANCE BY THE GRANTING OF A
SCHOLARSHIP AND NEITHER THE SCHOLARSHIP COMMITTED NOR MCDONALD'S HAS ANY OTHER OBLIGATION OR RESPONSIBILITY
WHATSOEVER TO ME.
_____________________________________________________________________ ___________________________
STUDENT SIGNATURE DATE