NAME: ____________________________________/____________________________

                               Last First Initial                                         Name of High School
 

Do you have a definite vocational choice? _____________________________________

If so, in what field? _______________________________________________________
 

Name of accredited college you plan to attend: __________________________________
 

Have you been approved for admittance next fall? ______________________________
 

Your address ______________________________ Date ________________________

                      ______________________________ Phone No. ____________________
 

Date of Birth _______________________________ Date of Graduation __________________
 

Counselor's Name ___________________________ Principal's Name ___________________
 

Parent(s) or Guardian(s) Full name(s) ______________________________________________
 

Occupation of Father or guardian _________________________________________________
 

Occupation of Mother _________________________________________________________
 

How many of your family including you, will be in school beyond high school this fall? _____. Do you have a part time job? _______ If so, your weekly salary? ___________

How much do you expect to have saved by this fall? _________.
 

Names of Brothers and Sisters _____________________________ Age _____________

                                               ______________________________ Age _____________

                                               _______________________________Age _____________
 

Date joined, Chapter Name and Number to which Father, Mother, Guardian or you belong: _______________________________________________________________________

_______________________________________________________________________________________________________
 

(Note: Parent, Guardian or you must have been a member of an Ahepa organization for at least two (2) years prior to March 1^st of this year.)
 

School Activities ________________________________________________________________________________________

______________________________________________________________________________________________________
 

Additional Youth Activities__________________________________________________________________________________

______________________________________________________________________________________________________
 

Athletic Activities in which you engage, either on school teams or for recreational purposes ("V" for Varsity after sports) _____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________
 

Special Talents ________________________________________________________________________________________
 

Special Interests _______________________________________________________________________________________
 

Work Experience ______________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________
 
 
 

Signature                                                                                 Date
 

____________________________________________        ______________________
 
 
 

Please Note: This completed form along with a transcript of your grades and letters or recommendation from your Principal and/or your Counselor must be received no later than May 1^st (postmark) by the Chairman of the Scholarship Committee in order for your application to be considered..

The applicant must have a minimum 2.75 cumulative grade average to apply.

(Note: Parent, Guardian or you must have been a member of an Ahepa organization for at least two (2) years prior to March 1^st of this year in order to be eligible.)
 

Mail your complete package to Pavlos Panagopoulos, 511 W. Reinken Ave., Belen, NM 87002. Telephone (505) 864-6675 or email pavlos@fnbelen.com
 

In the event you receive this applied for Scholarship but do not go to College, the award must be returned to the District.