Edmonton-Metcalfe County Chamber of Commerce
2012 $500 MCHS Memorial Scholarship
Must be submitted to the Chamber Office
PO Box 42, Edmonton, KY 42129
Deadline: April 1, 2012

Name_____________________________________________Phone____________

Social Security Number____________________ Email_______________________

Address____________________________________________________________

Birthdate__________________________________________Age_____________

Parents/Guardians Name_______________________________________________

Grade Point Average______Rank in Class_______ACT Score_________________

Intended Major______________________________________________________
College, University, or Technical School of Choice__________________________

Clubs (membership)____________________________________________________

Hobbies____________________________________________________________

List other scholarship you will receive or have applied for: ____________________
__________________________________________________________________Write a paragraph regarding your future plans (Use additional paper if necessary )