A CLUB, A COMMUNITY, A FAMILY

MENTOR SOCCER CLUB

2015 High School Senior Award Application and Questionnaire

1. Name in full:      

2. Address Street:      Apt. #:      City:       State:       Zip Code:      

3. Home Phone Number:      

4. Birth Date:      

5. Are you a graduating high school senior, or home schooled student, attending college, trade school, or other post secondary educational establishment in the fall? Yes No

6. How many years did you play soccer in the Mentor Soccer Club (Ages 5 – 18)?      

7. List any volunteer involvement (and relevant dates) that you (applicant) or any family members have contributed to the Mentor Soccer Club. This includes refereeing for Mentor Soccer Club recreational soccer games, and camp counseling for MSC summer programs.

Applicant:      Family:      

8. List any additional high school extracurricular activities in which you took part, awards and honors you received during high school (include the years and level of participation), and any other volunteer activities.     

9. At what institutions of higher learning have you applied? (In order of preference/status, ie school name/applied, accepted, decided).

A.      B.      C.      D.      

Signature of Applicant: ____________________________________ Date:      

* For purposes of this application, high school is defined as grades 9-12.

**Required attachments to be submitted with this questionnaire are: Current high school transcript including class rank and Cummulative Grade Point Average

(most recent grading period) verified by authorized signature. If you are a Home Schooled student, please submit an appropriate record of academic achievement (SAT/ACT scores, GED, etc.)

Letter of recommendation from your high school principal, guidance counselor, teacher, civic/spiritual leader.

Items in this area are for the use of the Mentor Soccer Club – DO NOT WRITE OR PLACE MARKS IN THIS AREA.

Applicant Number: _________ Phase 1 Status: _______