GFMHSF Academic Scholarship Application Step 1 of 4 25% ApplicantName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone Number*Email* Parent/GuardianName First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone NumberEmail Applicant InformationDate of Birth* Date Format: MM slash DD slash YYYY Year of Graduation*201420152016201720182019202020212022GPA*Please enter a number from 0 to 6.Name of High School*Number of years playing hockey*Please enter a number from 0 to 20.Name of last Des Moines hockey program*Current team name* List of colleges and/or vocational programs you have applied for?*What are your academic interest(s)?*Please list any extracurricular activities (including volunteer community service and/or organizations) that you participate in outside of hockey.*Please list two references and their phone number.* Include ALL of the following with your completed application: A one page personal statement that should include how playing hockey has influenced your life, your goals for the future, special or unusual circumstances, financial need and/or any other important information you would like to share. A letter of recommendation from a coach, teacher, employer, etc. Personal Statement* Drop files here or Accepted file types: jpg, jpeg, png, pdf, tiff, doc, docx, pdf. Letter of Recommendation* Drop files here or Accepted file types: jpg, jpeg, png, pdf, tiff, doc, docx, pdf. By signing this application, you agree that, if you receive a scholarship, the GFMHSF may make public your name (and that of your parent(s), guardian, or spouse, if applicable), the amount of the scholarship, the school that you will be attending, and a brief summary of your qualifications and plans. You are also agreeing to be contacted by a representative of the GFMHSF as appropriate. This agreement will be in effect as long as you are a scholarship recipient. I certify that the information provided in this Application is accurate, and I give authorization to the Gabe Fleming Memorial Hockey Scholarship Fund to verify the information contained within this Application. Deliberate misrepresentation of material facts in this Application is cause for disqualification. I understand that academic scholarships are granted through a confidential Board of Trustee process based upon outlined criteria; there is no guarantee made regarding the awarding of financial assistance or the amount of any award. I also understand that the Fund’s academic scholarship awards are determined annually, and I may only receive a total of one academic scholarship.Signature of Applicant or Parent/Guardian*
