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KYDepartment of Education

Mary Jo Young Scholarship Application for Dual Credit Courses (Fall 2006)
Last updated on Friday, July 29, 2005

The Mary Jo Young Scholarship, which is sponsored by the Kentucky Higher Education Assistance Authority, covers the cost of tuition, materials and test preparation for approved dual credit courses offered throughout the state of Kentucky.

Note: Applications must be submitted by Oct. 15, 2006.

Students receiving a scholarship agree to complete all required work for the course and complete a post-course evaluation that will be sent to the school's guidance counselor.

Priority will be given to low-income and minority applicants.

Personal Information
First Name

Middle Initial

Last Name

Your Home Address

City

State

Zip Code

Home Phone Number (with area code)

Your E-Mail Address

Grade In School for 2005-2006 School Year

       9

       10

       11

       12

       Other Grade (please indicate)  

Ethnicity (optional)
       Caucasian

       Asian

       Native American

       African American

       Hispanic

        Other (please indicate)  

Are you receiving free and/or reduced price lunch?
       Yes

       No

School Information

Your School District

Your School

Your School's Address

City

State

Zip Code

School Phone Number (with area code)
About Your Dual Credit Course


University or College Name:


Registrar's Address:


City

State

Zip Code


First Course for which you are Applying for Dual Credit:
        Course Title
       
        Course Number
       
        # Credit Hours
       
        Semester in which the course will be taken
       
        Location of the course - high school building, college campus, etc.
       
        Instructor's Name
       

        Describe how this course aligns to your Individual Graduation Plan (IGP)--maximum 300 characters
       


Second Course for which you are Applying for Dual Credit:
        Course Title
       
        Course Number
       
        # Credit Hours
       
        Semester in which the course will be taken
       
        Location of the course - high school building, college campus, etc.
       
        Instructor's Name
       

        Describe how this course aligns to your Individual Graduation Plan (IGP)--maximum 300 characters
       


List any previous dual credit courses you have taken:

Contact Information

Please provide contact information for a teacher, counselor or administrator who will recommend you for this scholarship:

Name:

Title:

School:

Phone with area code:

E-Mail Address: