CENTENNIAL HIGH SCHOOL CHIVALRY SCHOLARSHIP QUESTIONNAIRE

The CHS Athletic Booster Association will present one $2000 scholarship to an outstanding senior class female student/athlete and one $2000 scholarship to an outstanding senior class male student/athlete at the annual Honors/Awards Ceremony.

Each student/athlete shall be selected based on their academic and athletic achievements, as well as other extra-curricular activities at the high school and/or in the local community.

You have been nominated by your coach for consideration of a Centennial High School Chivalry Scholarship.

Please complete all sections (typed) and return this questionnaire to the Centennial Front Office to be placed in the Umbrella Club folder by April 30th. Provide as much detail as possible. If necessary, attach additional pages to this application.

Student Name:

Section 1 Academic Information

Please provide the following information regarding your academic achievements, while enrolled as a student at Centennial High School.

Student numeric average (weighted): % (end of first semester senior year)

Student SAT score: Verbal Math Total (highest score in each category)

Other Academic Information: (list any ACT test scores, if applicable)

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Student Name:

Section 2 Athletic Information

Please complete all athletic achievements for each varsity sport in which you lettered. If necessary, attach additional pages to this questionnaire.

Varsity Sport:

Position Played:

Captain/Co-captain year(s):

Varsity Letter year(s):

Award(s)/year(s): (eg. MVP, Excalibur)

Honor(s)/year(s): (ex. All Region, County, State)

Varsity Sport:

Position played:

Captain/Co-captain year:

Varsity Letter year(s):

Awards(s):

Honor(s):

Specific Athletic Achievement(s): (ex. Pitched perfect game, 1,000 career points)

Athletic Record(s): (ex. State high jump record (2010))

Athletic Award(s): (ex. Wendy’s High School Heisman Award)

Athletic Scholarship: (ex. Wrestling – Duke)

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Student Name:

Section 3 Extra Curricular Activities

Please provide as much information regarding your extra-curricular activities at school and/or in the local community. The following categories are by no means all inclusive. If you participate in other organizations or clubs please list them at the bottom of this application.

Student Council / Class Office(s):

National Honor Society Office(s):

Club Office(s) and year: (ex. President Anchor Club – 2010)

Membership in Clubs (list club and year): (ex. French Club – 2010)

Band/Orchestra/Chorus (list years): (ex. Flute – 2009/2010/2011)

Drama/Theatre (list plays and role):

Other High School Clubs/Organizations:

Community Service Organizations: (ex. Habitat for Humanity)

Volunteer hours / week:

Leadership positions:

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Student Name:

Section 4 Additional Information (REQUIRED)

Have you been offered or applied for any scholarships through the NCAA?

Please use this space to provide any additional information for consideration or to elaborate on previous information. Some great ideas would be a narrative about what high school sports meant to you, a memorable experience you have had, or how you have positively impacted the community around you, through sports or otherwise.

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