Home Address: 

 Zip Code:   Phone: 

 Name of High School Applicant will Graduate from: 

 Planned College of Attendance:

 Planned Major:    Planned Career Field: 

 School/Community Activies and Honors (Identify grade level):                             

 Parent/Guardian's Occupation:

 Parent/Guardian's Occupation:

 Other Children Supported by Family (list by ages):

 Classes completed which are relevant to Public Works & Related Fields (math, science, computers, drafting,     english, accounting, etc.):

 Student's Plans, Ambitions and Financial Need: