Kenn Lockhart CSI Scholarship Foundation

4-Year & Higher Degrees

See Application Requirements for details about the application process and required suppporting documents

Download the Nomination Application in PDF

NOMINATION APPLICATION

Fields with * are required.

GENERAL INFORMATION 

 

1a. First Name: *

1b. Last Name: *

2. Current Mailing Address

 

2a. Street Address 1: *

2b. Street Address 2:

2c. City: *

2d. State: *

2e. ZIP Code: *

3. Permanent Mailing Address

Same as Current Mailing Address

3a. Street Address 1:

3b. Street Address 2:

3c. City:

3d. State:

3e. ZIP Code:

4a. Current Telephone: *

4b. Permanent Telephone:

5. Email: *

6. Are any members of your family active members of the Phoenix Chapter of CSI?:

7. Are any members of your family active members of another chapter of CSI?:

8a. Are you a student member of CSI?:

8b. If yes, what chapter?:

8c. If yes, in what activities have you participated?:

9a. Do you belong to any other organizations?:

9b. If yes, what organization(s)?:

9c. If yes, in what activities have you participated?:


ACADEMIC INFORMATION

 

10a. High school from which you graduated: *

10b. City: *

10c. State: *

10d. Graduation date: *

11a. College/University attending in fall semester: *

11b. Year currently attending: *

11c. Anticipated graduation date: *

11d. Major area of study: *

12. Previous college experience and area of study:

13. List membership in honor societies, school or study awards, extracurricular activities, and community involvement during college:

14. Are you currently employed or involved in an internship?: