Scholarship Application

Applicant's Name __________________________________________

Address: ________________________________________________

Parent(s) or Guardian's Name(s) and address ___________________________________

Party Affiliation:
Registered with the Democratic Party (or a declaration to do so at voting age)

Now Attending_________________________________________________

Student Classification (class ranking) _______________________________

Grade Point for last year of school ____________________________________________

School I plan to attend (must be a Kentucky school) ______________________

Intended Major ________________ Minor _____________________

List your participation in the past General Election.

For example: working on behalf of Democratic nominees by registering voters, distributing literature, driving car, telephoning, and working at Democratic Headquarters before the election. Be specific; attach explanation on separate page; see format for applying. Submit two character references by persons not related to you, from:

1. School
2. Community
3. Special recognition or honors received

__________________________________
Applicant signature/date

RETURN TO YOUR SCHOOL COUNSELOR/CONTACTPERSON
NO LATER THAN DATE SPECIFIED

(The local/state committee reserves the right to not offer a scholarship in a particular year(s), at its discretion.)