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2010 Balanced Man Scholarship Online Application

Personal information
Name
Father's Name			Mother's Name
Address
City		State		ZIP
Phone #		E-Mail
Date of Birth		High School Graduation Date
Scholastic Information
High School Name
Un-Weighted GPA		Intended Major
ACT Cumulative		SAT Math		SAT Reading
Leadership, Activities, & Achievements
Please list briefly any activities you were involved in during your years in high school. Include any hobbies you had as well, even if they were not associated with your school. Please also list any honors, awards, or otherwise special distinctions you've received.
Activities and Hobbies
Honors, Awards, and/or Distinctions
Verification and Attachments
Please attach any documents you feel may be relevant during our review of your application (resume, letters of recommendation, etc.)
Attachments
Verification	I hereby swear that all information contained in this application is correct to the best of my knowledge and I have in no way provided false or untrue statements.