Name

    Address

    City

    State

    Zip

    What FTC Telecommunications Service Do You Currently Subscribe?

    Landline Telephone (please list telephone number)

    Broadband InternetFTC Security

    Contact Telephone Number

    Email

    Name of Parent(s) or Guardian(s)

    High School, Accredited College or Vocational-Technical School You Attend

    School Telephone Number

    Please select the category that applies to you. Only one should be marked.
    High School SeniorEnrolled College Student

    University or College You Plan to Attend

    Address of University or College

    ACT/SAT Score

    GPA

    Have You Been Awarded Any Other Scholarship(s)? YesNo

    If Yes, Please List Them and Amounts

    *Optional

    Additional information for special consideration (ex. Siblings in college, healthcare expenses, household income, number of siblings, other)


    Applicant Certification

    I hereby certify that the information on this application is complete and correct to the best of my knowledge.

    Name of Applicant

    Date


    High School/College Honors and Awards (May be included on resume)

    Community Activities in Which You Have Been Involved (May be included on resume)

    Brief Summary of Your College, University or Vocational-Technical Plans

    Brief Summary of Your Career Plans

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    Upload Letter of Recommendation

    Upload Educator's Letter of Recommendation

    Upload Transcript