DEADLINE: MARCH 4TH, 2021
Home Phone Number
Cell Phone Number
Date of Birth
Parents or Guardian
By applying for this scholarship, I give The Ruby Holland Foundation, LLC. permission to publish my name and/or utilize my photograph.
High school name and address District GPA Florida GPA Score on SAT, if taken Score on ACT, if taken Classes taken for High School Credit: Number of AP Classes Number of IB Classes Number of Dual Enrollment Classes Number of Honor Classes List any Scholastic or Academic Awards (9-12)
Are you a dependent (claimed on parents’ income tax) or independent?
Under $25,000$25,000 to $40,000$41,000 to $65,000over $65,000
Who contributes money for your education? (parents, self, other) Please list:
List any scholarships, grants, and loans you are receiving or for which you have applied.
Are you employed? If yes, where? How many hours do you work weekly?
You must complete Section C using this form only.
List total hours of Community Service
List Community and/or School-Related Extra-Curricular Activities such as Clubs/Organizations (Grades 9-12)
List Community and/or School-Related Sports Participation (Grades 9-12)
List Community and/or School-Related Music/Theatre/Drama/Dance Participation (Grades 9-12)
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Email the below listed documents to firstname.lastname@example.org All documents must be received before midnight of the deadline date of 11/20/20