Herbert V. Johnson Family Questionnaire

Herbert V. Johnson Family Scholarship

Thank you for applying to the Herbert V. Johnson Family Scholarship. You have advanced to the final round and there are a few additional questions we need you to answer. Please submit this form by Monday, July 11th. Thank you!

"*" indicates required fields

Name*

First Last

Email*

Phone*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Birth Date*

MM slash DD slash YYYY

Gender at Birth*

Are you planning to attend an in-state or out-of-state school*

In-state

Out of state

Are you planning to attend a public or private institution?*

Public Institution

Private Institution

What is the name of the school you plan on attending?*

High School Graduation Year*

GPA*

Please enter a number from 0.0 to 4.0.

Have you been accepted to this school yet?*

Yes

Approximately what percent of your tuition, room & board, books, fees is covered by other scholarships?*

0% – 25%

25% – 50%

51% – 75%

76%+

Which of these statements best describes your education status? Select all that apply*

I will not be able to attend college without funds from the Herbert V. Johnson Family Scholarship

My parents are paying for the majority of my college expenses, including tuition

I plan on working at least part time during college

I will need to take out student loans to help pay for college

Consent*

I acknowledge that, by clicking the checkbox as my official signature, I agree to the Official Scholarship Rules as well as EducationDynamics Privacy Policy.

Name

This field is for validation purposes and should be left unchanged.