Scholarship Application

Upload a High School photo*

Max. file size: 50 MB.

Upload Transcript*

Max. file size: 15 MB.

Name*

First Last

Date of Birth

Phone*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Email*

Father's Name*

Father's Occupation*

Mother's Name

Mother's Occupation*

High School*

High School Address*

Street Address Address Line 2 City State ZIP Code

High School Contact Name & Phone*

How many children are in your family?*

How many will attend college this year?*

What college or university do you plan to attend?*

Major field of study?*

Have you been accepted for enrollment?*

Have you received other scholarships?*

If so, which ones?

List any Awards and Honors you have received.

List any organizations or community activities you have been involved with

List any jobs you have held, including employer's name.*

High School Ranking*

GPA*

Did your school host a Rexanna’s Foundation Team event or other Fundraiser; Bracelet Drive, 60 Seconds of Hope, Run for a Purpose or other?*

If the answer is yes – how did you participate? Also tell us about the event

Write a composition no more than 500 words stating how you have been impacted by cancer. Include how the experience with cancer has affected your plans for the future and how the experience will help you be more successful in your future collegiate endeavor.*

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