Fathers. M.I.A. "All About Him" Bowling for Dollars! 2021 " As We Honor Her" Gala Application Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone Number *Email *Address *Date of Birth *Gender *MaleFemaleEthnicity *White / Non HispanicAfrican American / Non HispanicHispanicNative Hawaiian or Other Pacific IslanderAmerican Indian or Alaska NativeOtherRace does not affect the outcome of our decision making process. Grade *9th Grade10th Grade11th Grade12th GradeHigh School *School NameGPA *Prospective Colleges *Intended Major/ Concentration *Extracurricular Activities *Activities ( Includes clubs and sports )Honors / Awards / Achievements *Tell us a little about yourself. ( Family, friends, schools, and special interest, community involvement, hobbies) *What best describes your father? *DeceasedEstrangedUnknownDescribe a powerful moment that you remember about your father. *Are you currently employed? *YesNoHow did you hear about us? *If possible would you be willing to restore your relationship with your father? *Please describe the impact of being fatherless and how this scholarship will benefit your future academic goals. ( Your Essay should be between 200-300 words) High School Seniors Only! *This Essay is Mandatory for High School Seniors only , all others please type NA ( Not Available)Parent / Guardian Information *FirstLastHome Phone *Cell PhoneEmail *Parent / Guardian Email.PhoneSubmit Student Application Form Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *City *State *ZipTelephone(H) *(Cell)Participant’s Email *Date of Birth *AgeEthnicity *Native American or American IndianHispanic or LatinoBlack or African AmericanWhiteAsian / Pacific IslanderOtherParent/Guardian InformationParent / Guardian Name *Phone *High School *Grade *GPAProspective Colleges *Intended Major/Concentration Proof of acceptance or current enrollment is required prior to funds being released to the college or university Extracurricular ActivitiesActivities (includes clubs and sports)Honors/Awards/AchievementsAll About Him!Tell us a little about yourself (Family, friends, school, any special interest, community involvement, hobbies)Describe a powerful moment that you remember about your father *Essay for Seniors ONLY Please describe the impact of being fatherless and how this scholarship will benefit your future academic goals. Your essay should be between 200 and 300 words. If you provide this essay on a separate document, please include your name and email address at the top of your essay.Additional InformationAre you currently employed? *YesNoWhich would you say best describes your father?Estranged / Known and not activeUnknownDeceasedIf possible, would you be willing to restoring your relationship with your father?Acknowledgements and Signatures Candidate My signature below confirms that I have provided complete information in this application and that I understand that I may be contacted if there are questions or concerns about my application package.Date *Parent/Guardian If selected, I give my son permission to participate in the “As We Honor Him”, Bowling For Dollars, presented by Fathers M.I.A. .Parent/Guardian’s Name (Printed) *DateParent/Guardian’s SignatureDateImage Release Form I grant to Fathers M.I.A. and their representatives (hereinafter “Sponsors”) the right to take photographs, videos, or other visual media of me and my property relating to the “All About Him” Bowling For Dollars, including any culminating events. I authorize Fathers M.I.A. and Sponsors to copyright, use and publish the same in print and/or electronically. . I agree that Fathers M.I.A. and Sponsors may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content. I have read and understand the above.Printed Name *Submit
