George L. and Genevieve D. Moore Family Endowed Scholarship – Application Scholarship Application – George L. and Genevieve D. Moore Family Scholarship Personal Information First Name * Last Name * Date of Birth * Email * Home Phone Cell Phone * Address Street Address Street Address Street Address Street Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Background Information Father’s Name Father’s Occupation Mother’s Name Mother’s Occupation Education Information Current School Cumulative GPA ACT Score SAT Score College, University, or Technical College planning to attend Intended Major Annual Cost to Attend $ Other Scholarships or Grants Have you applied for a Pell Grant? Yes No Amount $ Have you applied for other scholarships or grants? Yes No How Many? (up to 5) One Type Scholarship Grant Name Amount (If Awarded) $ Two Type Scholarship Grant Name Amount (If Awarded) $ Three Type Scholarship Grant Name Amount (If Awarded) $ Four Type Scholarship Grant Name Amount (If Awarded) $ Five Type Scholarship Grant Name Amount (If Awarded) $ Financial Information How do you plan to pay for the portion of your education not covered by grants and scholarships? Current Work Information Employer * Position * Start Date * Average Weekly Hours * Hourly Wage * $ ~ Past 12 Months Income * $ Essay Essay (not to exceed 500 words). Describe your views on leadership and character citing examples of your personal leadership ability and character. * In order to be eligible to receive a George L. and Genevieve D. Moore Family Scholarship, the applicant must meet the below requirements State that your DO NOT use tobacco in any form I DO NOT use tobacco I DO use tobacco State that you earn an income (over 12 months) equal to, or greater than, the amount of the requested scholarship I DO I DO NOT Printed Name * Date Submitted * By submitting this electronic application, I certify that I reviewed the information and to the best of my knowledge it is accurate. The Committee will use this application to determine scholarship recipients. If you are human, leave this field blank. Submit Δ