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Full Name: Street Address: City, State and Zip Code: Permanent Address (If different, from address above): Home Phone Number with Area Code: Cell Phone Number with Area Code: E-mail Address (required): Social Security number (required): Current High School or College: Name of college the applicant will attend during the 2012-13 academic year: High School Graduation Date (if High School Student) or Anticipated College Graduation Date (if College Student): Select one category: o Print
o Communications (Print Journalism, Public Relations, Advertising) o Broadcast (Television or Radio) o Visual Arts/Multimedia (Photojournalism, Graphic Design, Web Site Design)
The statements I have made in this application are true, accurate, and complete.
Signature
Date
DEADLINE: Application must be postmarked by Friday, June 1, 2012
Return this application form, along with the required items, in one envelope or package to:
SAAHJ 2012 Scholarship Committee San Antonio Express-News, P.O. Box 2171 San Antonio, TX 78297-2171
Questions? Contact Scholarship Committee Co-Chairs Javier Flores (210-207-2098 / javier.flores@sanantonio.gov) or Isis Romero (210-351-1343 / iromero@ksat.com) 1
Shipping instructions: Submit the completed application with required items in one envelope/package to: SAAHJ 2012 Scholarship Chair, P.O. Box 2171, San Antonio, TX 78271-2171 DEADLINE: Application must be postmarked by Friday, June 1, 2012
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