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NICHOLAS LEAKINS
COLLEGE BOARD SAT
SCHOLARSHIP APPLICATION


APPLICANT'S NAME:
LAST                                    FIRST                               MI


APPLICANTS ADDRESS:

Parents email address_________________________________________________________________

STREET NUMBER AND NAME
CITY / STATE / ZIP CODE
HOME / CONTACT TELEPHONE #:  (       )                                        GRADE/AGE:             /
                                                                                                          FIRST TIME SAT
CURRENT GPA:                                OVERALL GPA:                                    YES  /  NO  

HIGH SCHOOL ATTENDING:

HIGH SCHOOL COUNSELOR OR MENTOR:

STUDY AREAS OF INTEREST (IF DECIDED):                        

NAME OF PARENT/GUARDIAN:
(REQUIRED IF UNDER AGE 18)

ANNUAL HOUSEHOLD INCOME:    $
By signing below, you are certifying that all of the above information is accurate and true.  You are also authorizing Basketball Coaches Without Boundaries, Inc. (BCWB) to verify  said information with High School Officials, if necessary, for the awarding of this scholarship  only.  By signing below I also permit BCWB to list my child's name in any award recognition  advertisement.  BCWB will in no way use this information for anything other than the intended  purpose of awarding this scholarship and advertisement of it’s recipient.  No individual income  or GPA information will be released without the written consent of the student and
parent/guardian (if under age 18).
APPLICANT'S SIGNATURE                                                            Date_________________
PRINTED NAME:

PARENT/GUARDIAN SIGNATURE:                                                   Date_________________
PRINTED NAME:

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