First Name

Last Name

Email

Phone

Graduated from high school and admitted to a 4 year college, a community college, or a certified trade training? Yes No In progress (will be admitted/enrolled soon)

Hispanic or of Hispanic descent? Yes No

If yes, what's your background?

Bilingual ability preferred (do you have bilingual ability?) Yes No Some (Conversational)

Citizen or legal resident of the United States (foreign students with student visas do not qualify) U.S. Citizen Legal Resident Other / Not Sure

Resident of Mobile or Baldwin counties? Mobile County Baldwin County Neither

Do you have proof of financial need with a copy of FAFSA or other acceptable documentation? Yes No

Not a Board member or close relatives of HABAGCs Board members or Scholarship Committee members? Yes (I am not a Board member and not a close relative) No (I am a Board member) No (I am a close relative of a Board member)

Have you received the HABAGC scholarship before? Yes No

If yes, how many times? 1 2 3 N/A

Where do you plan to go to College/University?

Would you be interested in volunteering with HABAGC? Yes No