Scholarship of Honor Application

More than 50 million brave young men and women have served our country in uniform with honor. As proud Americans we salute their efforts. We look for ways to instill in others the pride and determination of those who gave so much of themselves for others and most of all, we have made a vow to remember.

In an effort to always remember their courage and patriotism, the Brian LaViolette Scholarship Foundation honors them with the Scholarship of Honor. Our goal, and those who contribute to this Scholarship of Honor program, is to assist you as you follow your aspirations.

This scholarship recognizes a graduating high school senior with plans to enlist in the military or pursue a career in public safety or community service. (fire safety, police science, teaching, nursing, EMT, ministry, and other noble causes.)

Please select the scholarship you are applying for

From the list below

Name

First Name

Last Name

Middle Initial

Phone

(###)

###

####

Email Address

General email address that will be used after High School

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

SCHOOL INFORMATION

Grade Point Average (GPA) - High School

Number of Students in Class

Rank in Class or Laude Points

List in chronological order all schools attended in the last four years, including any summer or special courses.

Include - Name of school / Location (city) / Dates of Attendance

List any academic distinction or honors you have earned and the grade levels in which you earned them (9, 10, 11, 12)

ACTIVITIES

Note those activities in which you have been actively engaged (organizations, sports, or clubs) and which you feel have been most meaningful to you (include years of participation, grade, levels, and any offices held)

WORK EXPERIENCE

List employment you have held in the past three or four years

Position / Employer / During the Summer or School Year / Dates / Number of Hours Per Week

HIGHER EDUCATION, PUBLIC SERVICE AND MILITARY INFORMATION

If applicable, the College or University you have been accepted to

What field of study?

If applicable, the Branch of the Armed Forces you have been accepted to

Anticipated enrollment, or enlistment date

YYYY

Have you been awarded (or reasonably expect to receive) other grants or scholarships?

Yes

If yes, please list the name of the scholarship and the amount you will receive below

FAMILY INFORMATION

Parents: (Check if living)

Mother

Father

Stepmother

Stepfather

Legal guardian

Number of Children in Family

If you have siblings, number who will be in college

ESSAY

In a short essay, share why you believe you are deserving of a scholarship and how will you use your talents to make a difference in your community or this world. The essay must be typed and NO MORE THAN 500 WORDS.

REFERENCES

Letters of reference are not required. However, at least one reference and no more than two references of the applicant’s choice should be named. The selection committee reserves the right to contact these references. References cannot be family members or peers.

Include - Name / Phone #

DUE DATE

Please submit by March 30th unless stated differently guidance office

SIGNATURE

I certify that all the above information is true to the best of my knowledge.

Type name below

The SCHOLARSHIP OF HONOR recipient will receive a cash award as well as a specially designed SCHOLARSHIP OF HONOR medal during a public ceremony. Should you receive this scholarship, you are encouraged to stay in contact with the LaViolette Foundation and the sponsor of this award.

Today's Date

YYYY