High School Data

*High School

*Phone

*G.P.A.

*Address

*Graduation Date

*Guidance Counselor's Name

College Data

*HAVE YOU RECEIVED THE 'PROMISE SCHOLARSHIP?

Yes

*College you plan to attend

*City

*State

*HAVE YOU BEEN ACCEPTED?

Yes

*Type of school

*Major course of study

Extracurricular activities, position held

Community and volunteer activities, position held

Work Experience, position and brief description of your responsibilities

Awards and honors, describe the honors and why received

What is your personal reason for applying for this scholarship?

In your own words, what are the major obstacles facing the coal industry? (300 words)

Name of your relative who is currently employed or has been recently employed in a coal-related industry

Company’s name where your relative held a job

Attach a transcript (PDF)