Name

Address

City

State

Zip

What FTC Telecommunications Service Do You Currently Subscribe?
Landline Telephone (please list telephone number)
Broadband InternetFTCtv/Digital TelevisionFTC 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 StudentVocational-Technical School Student

College, University or Vocational-Technical School You Plan to Attend

Address of College, University or Vocational-Technical School

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

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