APPLICANT INFORMATION

Address (required)

Street Address Apt. or Unit #

City State Zip Code

EmailPhone Number (Including area code)

EDUCATION

Currently Enrolled in:High SchoolCollege or UniversityGraduate SchoolPost-Graduate Trade SchoolNot enrolled currently

If in college or other post-secondary institution, list most recent information first.

High School Attended:

High School GPA

From Date (mm/yyyy) To Date (mm/yyyy) Did you graduate? YesNo

College Attended:

College/University GPA

From Date (mm/yyyy) To Date (mm/yyyy) Did you graduate? YesNo

Other:

Other GPA

From Date (mm/yyyy) To Date (mm/yyyy) Did you graduate? YesNo

Field of Study (if applicable):

REFERENCES

Please list three professional or academic references.

Reference 1

Name Relationship
Company/Organization
Phone Number Email

Reference 2

Name Relationship
Company/Organization
Phone Number Email

Reference 3

Name Relationship
Company/Organization
Phone NumberEmail

ESSAY UPLOAD

Please upload your essay file here as a .doc, .docx, .txt, or .pdf file. Include your first and last name in the header on each page of the essay. Essay text should be double spaced and size 12-point Arial or Times New Roman font.

Select one of the following essay prompts and submit an original essay of at least 500 and no more than 1000 words.

1. Describe an experience you had with a member of the LGBTQ+ Community who is different from you. What was the situation? What was the outcome? What did you learn from this interaction?

2. What does LGBTQ+ community progress mean to your future?

3. Tell us about a time you came out to someone or shared something deeply personal with someone. How did it go? What did you learn about yourself and the other person?

In the last paragraph of your essay, tell us anything else we should know about you, any special considerations or obstacles you have had to overcome, and what this scholarship would help you do for your future education.

Along with your essay, you may include an academic resume providing information about extracurricular activities, community service, awards, and commendations. Please note, if you choose to submit your academic resume, it must be included with your essay as a single attachment.

Where did you hear about Hampton Roads Pride's Scholarship Program?

Choose OneScholarship FairFacebookSchool clubHamptonroadspride.orgAnother College Scholarship websiteHampton Roads Pride EventInternet SearchOther

If you wish, you may provide a link or links to your social media profile(s) here (such as Facebook, LinkedIn, etc.):

DISCLAIMER & SIGNATURE

I certify that my answers are true and complete to the best of my knowledge. Submission of this application constitutes consent to use my name, preferred pronouns, photograph, and/or video recording in print and/or electronic publicity of Hampton Roads Pride, if selected as a scholarship recipient. I understand that scholarship applicants who do not consent to sharing of their photograph and/or video recording by Hampton Roads Pride must notify the Scholarship Committee by email to scholarship@hamptonroadspride.org on or before the application deadline.

Typing your full name below will serve as your signature. Application is not considered complete until official transcripts from all educational institutions are received by Hampton Roads Pride.

Sign Here