The best way to utilize this document is to fill it in first, click print at the bottom of this page & print out 2 copies. Mail one copy to us & keep one copy for your records. You may also print the blank document, fill it in, and mail. Be sure to Include all supporting documents with your application. 
Please make sure you check for accuracy.  

Victoria Chapter API Scholarship Application

Please indicate the semester and year for which you are applying:

Fall Spring          Year

Personal Information

Full Name:

Soc. Security No.

Mailing Address:

Street or PO Box

City State   Zip   

Phone:

Marital Status:    Single     Married

Please indicate source(s) of financial support for your college expenses and the % you will receive from each:

Source

 % Source  %
1. Parents 5. Scholarship
2. Other Relative 6. Student Loans
3. Personal Savings 7. Other Sources
4. Wages    

Father’s Full Name:

Father’s Birthplace: City State

Father Living? Yes No

If father is living:

Telephone:

Father’s Address (street or box no.):

City State Zip  

Father’s Occupation:

Father’s Employer:

Mother’s Full Name:

Mother’s Birthplace: City State

Mother Living? Yes No

If mother is living:

Telephone:

Mother’s Address (street or box no.):

City State Zip  

Mother’s Occupation:

Mother’s Employer:

Present Academic Classification

Freshman      Sophmore      Junior      Senior    -------  High School    College

Schools Attended

High School(s) Attended

Name of School

City/State

Graduate?

Yes     No

Dates Attended

From                       To

1.

2.

3.

 

 

College(s) Attended

Name of School

City/State

Graduate?

Yes     No

Dates Attended

From                      To

1.

2.

3.

Employment Record (list most recent first)

1. Employer

City State Zip  

Phone

Type of work

Salary

Dates of Employment (from/to)

2. Employer

City State Zip  

Phone

Type of work

Salary

Dates of Employment (from/to)

3. Employer

City State Zip  

Phone

Type of work

Salary

Dates of Employment (from/to)

4. Employer

City State Zip  

Phone

Type of work

Salary

Dates of Employment (from/to)

College/University Which You Plan to Attend

College/University Name

City State

Degree Plan

1. Briefly describe your career goals:

2. List any recognition for excellence in scholastic work:

3. List any extracurricular activities in which you participate:

4. Please tell us why you want this scholarship and what receiving it would mean to you:

Mail your application and supporting documents to:

API Scholarship Chairman
PO BOX 5275
Victoria, Texas
77903-5275