Milk
Butter
Cheese

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Water
Beer

1. Name:
2. USF ID Number:
3. Address:
	Street Address		Apt#
	City	State	Zip	Telephone
4. General Information:
a. What is your gender?		--- Female Male
b. What is your marital status?		--- Married Single Other
c. Are you a Florida resident?		--- Yes No
d. County of Residence?		Choose a County Alachua Baker Bay Bradford Brevard Broward Calhoun Charlotte Citrus Clay Collier Columbia Dade DeSoto Dixie Duval Escambia Flagler Franklin Gadsden Gilchrist Glades Gulf Hamilton Hardee Hendry Hernando Highlands Hillsborough Holmes Indian River Jackson Jefferson Lafayette Lake Lee Leon Levy Liberty Madison Manatee Marion Martin Monroe Nassau Okaloosa Okeechobee Orange Osceola Palm Beach Pasco Pinellas Polk Putnam Santa Rosa Sarasota Seminole St. Johns St. Lucie Sumter Suwannee Taylor Union Volusia Wakulla Walton Washington
e. Occupation?
f. Number of hours worked?		Name of Employer?
5. Ethnic Origin (Optional):		--- White African-American Hispanic Asian/Pacific Islander American Indian or Native Alaskan Greek Other
6. Student Classification at USF for Fall 2014:		--- Freshman Sophomore Junior Senior 2nd Bachelor's degree Graduate Student
7. Anticipated date of Graduation:		--- Fall Spring Summer Year: Major:
8. Total number of family members in the household (include yourself):
9. * Please discuss your financial need and your educational goals for the committee to consider?
10. * Are you a community volunteer?		--- Yes No
List three organizations which you actively participate with:
I am applying for the following scholarship(s):
Apply only for the scholarships you qualify for.
Brunch on the Bay Endowed Scholars Program
Selby Foundation – Achievers Scholarship
Selby Foundation – Future Educators Scholarship
Laurey T. Stryker Scholarship For NEW Undergraduate Students
I certify that the information on this application is true and I hereby authorize the University of South Florida and any of its designated officials to release information from my official college records to the USF Sarasota-Manatee Scholarship Committee.
Check to certify your acceptance of the above statement.