Parent Teacher Student Association
NAME_______________________________________________
LAST FIRST MIDDLE
ADDRESS____________________________________________
______________________________________________________
CITY STATE ZIP CODE
Telephone Number__________________ Date of Birth_______
Grade Point Average_________
Are you a member of FMA PTSA? _____Yes _____No
Have you volunteered on behalf of FMA PTSA? ___Yes ___No
List all Academic Achievements, Honors, and Awards received since High School.
Academic/Honors/Awards Year
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
List all Community Involvement and Volunteer Experience you have participated.
Community Involvement/Volunteer # Hours Year
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
List all Extracurricular Activities, Hobbies, or Special Interests.
Extracurricular Activities/Hobbies/Special Interests Year
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Certification: I certify that all statements made on this application are true, complete and correct. I understand that failure to provide accurate information will disqualify me from receiving the PTSA Scholarship.
Signature____________________________ Date_____________