2023 Scholarship Application – Deadline January 31, 2023

Amicalola EMC Account Number of Your Home*
Name*
First Last
Last 4 Digits of SSN*
Home Mailing Address*
Street Address City State ZIP Code
Phone*
Email*
County of Residence*
Parents' Name(s)*
Name of High School*
Are You A Senior?*
High School Grade Point Average*
S.A.T., A.C.T., or COMPASS/ASSET Score(Deprecated)
Note if SAT score is based on old 2-part or new 3-part test
S.A.T. Score (Verbal + Math)
A.C.T. Score (Composite)
Membership in Organizations/Other Factors Which Influence Financial Need
Includes Offices Held and Honors & Recognitions
College or technical college which you plan to attend:
Financial Need Assessment
Will be handled as strictly confidential information.
Total Adjusted Gross Income for Household*
(from most recent income tax return, may ask for verification)
Other Factors Which Influence Financial Need (Depracated)
High School Transcript or Current College/Technical School Transcript*
Accepted file types: doc, docx, jpg, pdf.
Agreement*
- I certify that all information reported on this application is true and correct to the best of my knowledge. If I am selected as a finalist, i agree to submit a high resolution, digital photo by Feb. 24, 2023 for presentation purposes.

College or technical college which you plan to attend: