Application Form MHA Ronno Cook Memorial Scholarship Application Date* Name (first, middle, last)* Date of Birth* Mailing Address* E-mail 1. I plan to attend Western Piedmont Community College Fall 2019 Yes No What area(s) of study do you plan to pursue? 2. List your extracurricular activities and honors, talents, or hobbies. Attach an extra sheet if needed: File Upload: Upload 3. Describe any volunteer work in which you have been involved. Attach extra sheet if needed: File Upload: Upload 4. Attach up to 2 letters of reference from educators, employers, volunteer supervisors, or mentors. (not required) Reference #1 Upload Reference #2 Upload 5. Attach a 500-1000 word essay telling us about yourself and your educational goals (essay should be in Word format, 12 pt font, Calibri). Upload Submit
