Legacy Scholarship Application

Please fill in your details below.

Student Information:

Anticipated Start Date*

First Name*

Last Name*

Birthday*

Gender*

Email Address*

Phone Number*

Street Address*

City*

State*

Zip*

Background Information:

Enrollment Status*

Full Time

Part Time

High School Name*

High School Address*

City*

State*

Zip*

GPA*

GPA must be 3.0 or greater

Diploma Type*

Medical Allergies*

Parent/Guardian Information

First Name*

Last Name*

Email Address*

Phone Number*

(*) Denotes required fields