Preferred Pronouns:*Applicant’s Legal Name* First Last Applicant’s Preferred Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country CELL/HOME Phone:*DISTRICT STUDENT ID#*Birth Date* Date Format: MM slash DD slash YYYY GPA (unweighted/weighted)*Anticipated Date of Graduation*Personal Email* Which college, university, trade school or certification program will you be attending?City/State*Anticipated Start Date*List any awards and/or scholarships you have received. (Attach PDF or pages below as needed)*List any LGBTQ+ advocacy and volunteer experiences from the past two years. (include name of organization and a contact phone number). (Attach PDF or pages below as needed)List any volunteer experiences over the past two years. (include name of organization and a contact phone number). (Attach PDF or pages below as needed)*Describe your membership and/or leadership experience in campus or professional organizations. (Attach PDF or pages below as needed)*Choose 1 of the options below: Your response will in no way affect your eligibility.* I am willing to be recognized as the recipient of this scholarship (during a school board meeting, social and print media, and/or any other use as stipulated by Pasco Pride. I am unwilling to be recognized as the recipient of this scholarship (during a school board meeting, social and print media, and/or any other use as stipulated by Pasco Pride. Please sign below after reading the following statement:I understand that if I am selected for a PASCO PRIDE Scholarship: 1. All funds must be used for educational and training expenses; 2. I must remain enrolled, minimally part-time, for the entire academic terms (equal to 1 academic year) for which I am applying; 3. That I have already been accepted to the school/educational organization listed on my application; 4. I will never receive any portion of this scholarship, either as a refund or disbursement for my own, personal use; 5. That all information contained in this application is true and that failure to follow these requirements could lead to legal and financial obligations.SignatureTodays Date* Date Format: MM slash DD slash YYYY Incomplete applications will not be considered.Please answer the following questions by uploading a PDF for each: How would this scholarship help you attain your educational and professional goals? Explain why LGBTQ+ advocacy is important to you. Describe one of your volunteer activities which highlight your leadership experience. FINAL STEPS Upload the following to complete your application. (PDF only) Two letters of reference (one from a volunteer experience). A one-page essay explaining how your involvement in LGBTQ+ advocacy has impacted you and your community. An official school transcript. Please submit or mail your completed application by April 10, 2020.Upload all supplemental files here (PDF only)* Drop files here or Accepted file types: pdf. This iframe contains the logic required to handle Ajax powered Gravity Forms.