College Scholarship

Name*

First Last

Enter your full name

School Name*

Phone*

Email*

Enter Email Confirm Email

Address

City, State, Zip Code

Member of (check)*

Dubuque Senior High Key Club
Hempstead High Key Club

Hours of Service Recorded Last School Year*

Hours of Service – This Year (so far)*

Key Club Involvement (include offices, chairpersonships, as well as leadership events attended)*

Other School Activities and Sports

Community & Other Outside of School Activities*

Honors, Awards, and Special Recognition*

Scholarship Essay*

How will your involvement in Key Club influence your future?

Recommendation*

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 40 MB, Max. files: 2.

Two letters of recommendation are required that describe your leadership ability and service. One letter must be from the faculty advisor for your Key Club or another faculty member, no more than two pages in length, signed, and dated (no letters from family members please).

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In Service to the Children of Dubuque

Janel Geisert College Scholarship

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