Survey | Qualtrics Survey Software

First Name:

Middle Name:

Last Name:

Home Address:

Home City:

Home State:

Home Zip Code:

Home Phone Number:

Home E-mail:

Parents Names:

High school cumulative GPA:

SAT and/or ACT score:

What do you plan to major in/study while in college?

High school involvement and activities:

Please explain briefly how you heard about the Gongaware Scholarship and why you think you would be a great candidate for it:

High school guidance counselor and contact information for him/her: