Success Beyond the Classroom

Scholarship Application/Criteria
Please return this completed application by noon on Friday, March 11, 2011 to your school’s athletic director
or mail it directly to SBC by the deadline to:
Success Beyond the Classroom
5575 W. Broad Street
Columbus, OH 43228
Important: Applications received after the posted deadline will not be considered for this season’s SBC
scholarship awards.

Student Name School

Parent/Guardian’s Name Sport

Street Address

City, State, ZIP

Home Phone Cell Phone

Father/Guardian Employer
Circle one: Full Time Part Time

Mother/Guardian Employer
Circle one: Full Time Part Time

List SWCS activities (grades 7 to 12) in which you participated during the past twelve months.

How does your participation in sports help you to grow as a student? (Attach an additional sheet, if necessary.)

Tell us why you deserve a Beyond the Classroom Scholarship. (Attach an additional sheet, if necessary.)

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Which one do you qualify for? (circle one) Free Lunch Reduced Lunch No Assistance

Family Size Including Parents/Guardians:

During the last school year, how many students in your family (grades 7-12) participated in SWCS school
activities?

Please explain any special circumstances that might affect your eligibility for a Beyond the Classroom
Scholarship (include circumstances such as family illness, extraordinary medical expenses, job loss,
disability, etc.)

Please provide as much information as possible to help us make an informed decision.

Student Signature Date

Parent/Guardian Signature Date