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Contact
Home
Shop
About Successteam
Mission, Vision & Our Principles
Meet the Team
Our History
Our Sponsors
Our Partners
Our Programs
Big Brother
Back to School Bookbag Drive
PYD Academic Scholarship
College Bound: The College Tours
Adopt-A-College
Successteam Youth Council
Night of Champions
Ways To Support
Become a Member
Become a Volunteer
Donate
Give Corporate Sponsorship
Contact
DONATE
Academic Scholarship Application
Student Name
*
First
Last
Age
*
Birthday
*
Date Format: MM slash DD slash YYYY
Current Grade Level
*
9th Grade
10th Grade
11th Grade
12th Grade
Current High School
*
Current GPA
*
Email
*
Phone Number
*
Home Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Shirt Size
*
Small
Medium
Large
XL
2XL
3XL
4XL
Favorite Color
*
Current Extracurricular Activities
*
Participant Race/Ethnicity
*
Black/African-American
White/Caucasian
Hispanic
Asian
Hawaiian
Biracial
Annual Household Income
*
(Answering this question will help us qualify for future grant opportunities)
Under $33,000
$33,000 - $52,700
Over $52,700
I choose not to answer even though this information is helpful and will not be disclosed or affect my child’s program eligibility.
What Are Your Plans After High School?
*
2-Year College
4-Year College
Military
Entrepreneurship
If College, list your top 3 school choices
*
If Military, list which branch you're most interested in
*
If Entrepreneurship, list the business type you're pursuing
*
Are You A First Generation College Student, The First in Your Family to go to College?
Yes
No
Please Submit a 1 - 2 Page Essay Answering The Following Questions:
*
Who you are? What's your dream or passion? What are your college aspirations? Intended Major? College of Choice? How has your life experience impacted this decision? How do you plan to impact your community in the near future? Why should you be chosen to receive this scholarship?
Essay Requirements: Essays should be no less than 500 words in length. Focus on your career aspirations and goals to complete.
Phone
This field is for validation purposes and should be left unchanged.
