Grayville Scholarship Application

Application Deadline: April 1st of each year

To qualify for The Grayville Scholarship:

Submit this application. Review the questions and prepare your answers before completing the application as your information will not be saved if you leave this page before submitting the form.
Provide the academic documentation form completed by your high school guidance counselor.
Submit academic documentation form by email to Sharon Broster Walden or mail to:
Sharon Broster Walden
209 Loren Drive
Grayville, IL 62844

The directors of The Grayville Scholarship review the applications and announce the winner during the Grayville High School commencement.

Applications received after the deadline will not be considered.

Personal Information
Name*
First Middle Last
Email*
Phone*
Date of Birth*
Year of Graduation/GED*
Address*
Street Address City State ZIP Code
Father's Full Name
First Middle Last
Father's Occupation
Mother's Full Name
First Middle Last
Mother's Occupation
Number of children in family (including yourself)
Number of children living at home (including yourself)
Describe any health or physical handicaps:
Health or physical handicaps
Describe any financial assistance you have received or have applied for to pursue your course of study. Identify the source and amount, if known:
Financial assistance
Activities and Honors
In what civic and/or religious activities (not directly related to high school) have you participated?
Civic and/or religious activities
In what school activities, clubs, and/or organizations have you participated?
School Activities
List the honors you have received (include both school and not directly related to school):
Honors
Personal Evaluation and Goals
State your educational plans for the fall.
Personal Evaluation Part 1
Write a summary telling us something about yourself and your future aspirations.
Personal Evaulation Part 2
Write a summary about someone who has had an influence on your life and why.
Personal Evaulation Part 3
By submitting this application for the Grayville Scholarship, I hereby certify the statements herein are true and correct to the best of my knowledge.
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