Five-O's Tiki Foundation Scholarship Application

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Contact Details

Applicant's Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Cell Phone Number

Address(Required)

Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code

Applicant's Date of Birth(Required)

MM slash DD slash YYYY

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Applicant's School Infomation

Student’s High School Attending:(Required)

Date of Graduation(Required)

MM slash DD slash YYYY

GPA(Required)

Student will attend Postsecondary School:(Required)

Major/Field of study

Address of Postsecondary School:(Required)

Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code

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Parental Information

Dad's Info

Father's Name

Father's Cell Phone

Address

Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code

Is Father Active or Retired Law Enforcement?

Yes

No

What Jurisdiction?

Mom's Info

Mother's Name

Mother's Cell Phone

Mother's Address

Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code

Is Mother Active or Retired Law Enforcement?

Yes

No

What Jurisdiction?

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Required Documents

Please upload the following:

• Resume (no longer than two pages)
• Essay (name only on the top of first page)
  • Submit an essay between 350-450 words (typed, double spaced in Times New Roman 12) discussing “Decision making is increasingly difficult among younger people, explain a situation where you had to make a difficult decision in your life, explain how this decision has shaped your character and how your decision had influenced others.” Only the top of the first page will contain the scholarship applicant’s name and the content will not mention any family names or jurisdiction. The essay will be read, evaluated objectively and anonymously by the scholarship board. (Please do not include any personally identifying information in the essay).
•  Acceptance Letter from an accredited college/university or technical/trade/vocational institution in the United States.
• List the voluntary services performed and/or participating in during the past three years
  • Include a description and time frame. These details must be typed on a separate sheet of paper with your name on the top.
• Recommendations letters from three respective leaders in your community.

Public School Students:

• High School Transcript (9 th thru 12 th grade)
• Standard of Learning (SOL) Scores or Equivalent

Home-Schooled Students:

• Home School Transcript (9 th thru 12 th grade)
• National Standard Test Scores or Equivalent

File(Required)

Drop files here or Select files

Accepted file types: docx, pdf, doc, Max. file size: 50 MB.

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Certification

*I am the sole author of the essay “Decision making is increasingly difficult among younger people, explain a situation where you had to make a difficult decision in your life, explain how this decision has shaped your character and how your decision had influenced others.”(Required)

Yes

Applicant's Electronic Signature(Required)

Signature

Type your full name. This will serve as your binding signature.

Date(Required)

MM slash DD slash YYYY

Mother's Electronic Signature(Required)

Signature

Type your full name. This will serve as your binding signature.

Date(Required)

MM slash DD slash YYYY

Father's Electronic Signature(Required)

Signature

Type your full name. This will serve as your binding signature.

Date(Required)

MM slash DD slash YYYY

Phone

This field is for validation purposes and should be left unchanged.

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