Application

OAK CREEK

SAFE SPACE SCHOLARSHIP

APPLICATION FORM

Application

Legal Name:

Preferred Name:

Home Address:

Telephone:

Email:

Date of Birth

Parent / Guardian Name:

Parent / Guardian Home Address:

Parent / Guardian Telephone:

Parent / Guardian Email Address:

Do you identify as a member of the LGBTQ+ community? If so, please describe how.

Name of High School:

Expected Date of Graduation:

Current Year / Class:

Cumulative GPA:

Class Rank:

ACT / SAT Score:

Extra-Curricular Activities:

College(s) Applied To

College(s) Accepted To:

Major / Minor:

In 500 words or less, please describe how you proactively made Oak Creek High School a safe space for LGBTQ+ students. Please see Selection Criteria for examples of proactiveness.

I hereby state that all the information provided in this entire application is, to the best of my knowledge, truthful. I am aware that I will be disqualified if the Oak Creek Safe Space Scholarship Committee discovers that any of my materials are untruthful or fraudulent.

Date:

Signed:

Upload PNG or JPEG file:

Useful links

Contact info

Oak Creek Scholarship Foundation

7801 S. Howell Ave., Ste. 102

Oak Creek, WI 53154