National Minority Junior Golf Scholarship Association

Continuing Scholarship Application

NAME:____________________________ SOCIAL SECURITY #:_________________

HOME ADDRESS:__________________________ PHONE: _____________________

CITY:_______________________ STATE: ______________ ZIP: ________________

SEX:__________ EMAIL ADDRESS: _______________________________________

_____ ETHNIC DATA: Put appropriate number in the box.

African- American 4. American Indian/ Alaskan Native

Hispanic 5. Other ____________________

Asian/Pacific Islander

_____ GRADE POINT AVERAGE

College you attended this year: __________________________ Major: ______________

Year in college: _______________

College you plan to attend this upcoming school year: ____________________________

With this application please enclose:

An official transcript from FALL semester or last quarter.

A color headshot. (Photos will not be returned)

List if you are currently on your school’s golf team (if applicable).

List golfing accomplishments (if applicable).

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

Signature of Applicant Date

This application and all requested materials must be postmarked by May 15^th, 2007

Mail to:

The Bill Dickey Scholarship Association
Formerly National Minority Junior Golf Scholarship Association

1140 E. Washington Street, Suite 103 Phoenix, AZ 85034

Questions? 602-258-7851