Your application will be disqualified if not answered completely as instructed.
Please fill in all fields; incomplete applications may not be considered.
First Name: MI: Last Name: PBSC Student ID #:
Street Address: City, State and Zip:
Home Phone: Cell Phone: Which campus do you plan to attend?:
Palm Beach Gardens
Hispanic: Yes No High School:
By the end of the 2016-17 school year, I will have earned:
Standard High School Diploma
Certificate of Completion
FAFSA Application Completed: Yes No PELL Grant Eligible: Yes No Waiting To Hear
Dual Enrolled: Yes No Advanced Placement Credits: Yes No
AICE Credits: Yes No Magnet Vocation Program: Yes No
College Choice #1: College Choice #2:
I am seeking an AA – Transfer Degree or an AS degree: Yes No
How did you hear about the scholarship?:
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Apply only once, any additional application(s) will be discarded.