SCHOLARSHIP PERSONAL DATA SHEET
NOMINEE’S NAME___________________________________________________________
ADDRESS____________________________________________________________________
CITY, STATE, ZIP_____________________________________________________________
SOCIAL SECURITY NUMBER__________________________________________________
HIGH SCHOOL ATTENDED____________________________________________________
COLLEGE OR INSTITUTION ATTENDING OR PLAN TO ATTEND IN FALL OF
2011______________________________________________________________________________
ADDRESS OF STUDENT AID OFFICE___________________________________________
______________________________________________________________________________
PHONE NUMBER OF ABOVE OFFICE___________________________________________
FIELD OF STUDY______________________________________________________________
NAME OF NOMINATOR________________________________________________________
MEMBER OF CHAPTER________________________________________________________
GOOD SAM NUMBER__________________________________________________________
WHAT SAMBOREE IN 2010 or 2011 DID HE/SHE ATTEND________________________________
RELATIONSHIP TO NOMINEE____________
______________________________________