Are you currently a senior in high school?

yes no

Are you attending college or post-secondary education in the fall 2023 term?

yes no

Have you received the GCU National scholarship?

yes no

*Name:

*Date of Birth

*Last 4 Digits of Social Security Number:

*Home Address:

*Home Phone Number:

*Mobile Phone Number:

*E-Mail Address (this will be used for all correspondence):

*Name of School student is attending during the fall 2023 Term:

*Major:

*Total credits needed to graduate:

*Name of High School at which the student will be a senior during the Fall 2023 term:

*Year of anticipated Graduation:

*List any athletic accomplishments you achieved in your High School career:

*Name of School student hopes to attend in the 2024 Academic Year (1st choice):

Name of School student hopes to attend in the 2024 Academic Year (2nd choice - optional):

*Anticipated Major: