Writing Scholarships - Entry Form

Instructions:

1. Type your answers in the form, print 3 copies, and sign.

2. Submit a total of 3 copies of your essay, each having this completed formstapled to the top.

3. Send it to: RARE Everyday Hero Scholarship, 27500 Cosgrove, Warren, MI 48092

Student Information
First Name:
Last Name:
Gender:		Male Female
Home Address:
City:
State, Zip:		-
Preferred Phone:		- -
Email Address:
Parent or Legal Guardian:
Michigan College/University or Post Secondary School Planning on Attending:
High School Information
School Name:
School Address:
School City / Zip:		-
Teacher / Advisor Name:
Teacher / Advisor Email:
Teacher / Advisor Phone:		- -
Everyday Hero Information
Hero Name:
Hero's Phone Number:		- -
Hero's Email Address:
Hero's Place of Work:
Hero's Job/Occupation:
Street Address of Workplace:
City of Workplace:
State / Zip of Workplace:		-

Please place a check mark by the industry that best describes where your hero works:

Arts/Communication/Entertainment	Education	Non-Profit/Public Service
Automotive/Manufacturing	Food/Hospitality	Technology
Building/Construction	Health Care/Science	Other____________________

I am confirming that the information provided is correct and accurate to the best of my knowledge and that my essay is an original document and has not in any way been duplicated from another source.

_______________________________________________________________ Applicant Signature		____________________ Date

_______________________________________________________________ Teacher/Advisor Signature		____________________ Date