Personal Information

    First Name*:

    Middle Name:

    Last Name*:

    SSN*:

    Home Phone:

    Cell Phone:
    Wilcox County Physical Address:

    Street Address*:

    City*:

    State*:

    Zip Code*:
    Wilcox County Mailing Address:

    Street Address / PO Box*:

    City*:

    State*:

    Zip Code*:

    Email*:

    Gender:

    Place of Birth:

    Date of Birth*:

    Years Lived in Wilcox County*:

    Parent / Legal Guardian Information

    Father's Information

    Name:

    Address:

    Telephone:

    Occupation:
    Mother's Information

    Name:

    Address:

    Telephone:

    Occupation:

    Education Information

    Present Status*:

    Graduation Date:

    GPA*:

    ACT Score:

    Date Taken:

    High School Attended or Currently Attending*:

    If Other, please list:

    College / University Currently Attending:

    Proposed Major / Field of Study*:

    Has Your Major Changed*?

    Has there been a change in your goals in the past 12 months?

    Current or Past Simpson Foundation Support*:
    Plans for Continuing Education

    School Type*:

    Applying For:

    Proposed Major / Field of Study*:

    Anticipated Graduation Date*:

    First Choice School*:

    First Choice School Status*:

    Second Choice School:

    Second Choice School Status:

    Scholarships, Government Grants (FAFSA), Loans Applied For*:

    Scholarships, Government Grants (FAFSA), Loans Awarded Other than Simpson*:

    Work Record for Past 3 Years:

    Activities for Past 3 Years:

    Honors / Awards for Past 3 Years:

    In a brief statement, please explain what interests you about your proposed or current course of study*?

    Are you satisfied with your academic performance in the past year*?

    Please explain any poor grades received.

    Any additional information that would be of interest to the Trustees in evaluating this application?

    I certify that the information provided is complete and accurate to the best of my knowledge*: Yes

    Please check that you've filled in all the required fields.

    If you do not receive an email confirmation, please contact the Foundation to verify receipt.

    THESE ITEMS MUST BE RECEIVED BY THE FOUNDATION BEFORE SCHOLARSHIPS WILL BE PAID.

    Official transcript mailed to the Foundation by June 30th

    Student information forms

    Proof of Enrollment due by September 15