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First Step to Success

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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 #:

PBSC Email:

Street Address:

City, State and Zip:

Home Phone: Cell Phone:

Which campus do you plan to attend?:Hispanic: Yes No

High School:

By the end of the 2016-17 school year, I will have earned:

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

Anticipated Major:

How did you hear about the scholarship?:


Please review your information before submitting.

Apply only once, any additional application(s) will be discarded.



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