HOPE PLUS Scholarship Application
Name: First Middle Last
City: State Zip Code:
Phone: Home ( ) Cell: ( ) E-mail Address:
Birth Date: / / Sex: Male Female
United States Citizen: Yes No
Marital Status: Single Married
Have you ever been convicted of a felony? Yes No
High School Information
Name of High School: City State
Graduation Date: / /
List your three most significant honors and/or organizations:
List any extracurricular activities:
Jobs you have held (indicate dates):
Application continues on back
Provide a brief description of yourself, your goals, or anything else you want
us to know about you: (You may attach an additional sheet if necessary.)
I hereby certify that all information supplied by me in this application is accurate and complete
and that any misrepresentation of fact will constitute cause for nullification of my application
and scholarship eligibility including current and future years. In addition, I hereby grant
permission for The HOPE PLUS Scholarship Program and Augusta State University to include
my name on a publication of scholarship recipients and release information from the application
and from my academic and financial aid records to parties involved in the selection of HOPE
PLUS Scholarship Program recipients.
Applicant’s Signature: Date:
This application is incomplete without the following documentation:
Official high school transcript.
Letter of acceptance from Augusta State University.
Copy of the results of your processed Free Application For Federal Student Aid
(FAFSA), i.e., Student Aid Report (SAR).
Three letters of reference, with at least one being from a previous teacher or high
school administrator. References from family members will not be accepted.
If you have any questions please call Dr. Larry Hornsby at 706-860-1291.
Please mail application and documentation to Dr. Larry Hornsby, 711 Whittington’s Ridge,
Evans, GA 30809