Dan Starks Sr. & Otelia Starks Family Scholarship Application All sections must be properly filled out to submit your application for consideration. Name * First Name Last Name Sex Home Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Birthdate MM DD YYYY Phone (###) ### #### Name of Prospective College or Skilled Trade School School Address Address 1 Address 2 City State/Province Zip/Postal Code Country College Class Level Freshman Sophomore Junior Senior Graduate Post-Graduate Field of Study Anticipated Graduation Date MM DD YYYY Name of High School Attended High School Address Address 1 Address 2 City State/Province Zip/Postal Code Country High School Graduation Date MM DD YYYY High School GPA (on 4.0 Scale) High School Class Rank ACT Score Math Test Score Other Test Scores LSAT/MCAT/MAT/GED Military Service? Yes No Branch of Military Service Dates of Service Please enter the beginning and end dates of service if applicable Marital Status Single Married Divorced Widowed Separated Are you listed as a dependent on your parents/guardians' most recent federal tax return? Yes No List of names and ages of any dependent children List of Completed and Prospective Courses with Grades * List of Courses in your field of study that have been completed, and that you plan on taken. (If you are in high school, please list your high school grades). This information must be filled. "Refer to my transcript" is not acceptable. Awards and/or Honors Recieved Volunteer and/or Community Service Participation I have reviewed the information carefully before submitting and attest that all the information is accurate and complete * Yes Thank you for submitting your completed application. The committee will review your application and get back with you with a decision!