Puzzle Pieces

Scholarships

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BIPOC

LGBTQ

WInners

Scholarship Application

- Step 1 of 2

The Puzzle Pieces Marketing Scholarships are for students who will be pursuing post-secondary, undergraduate education in an accredited institution or program during the coming school year.

Applicants must be enrolled in an accredited institution of higher education, including vocational and technical schools and must be full-time students enrolled with a minimum of 12 units.

Which scholarship are you applying for? *

BIPOC Female
LGBTQ+ Youth

Apply Now *

APPLY NOW

Name *

First

Last

Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Race / Origin *

Gender *

Please specify *

Pronouns *

How do you identify? *

Please specify *

Nation of Citizenship *

Native Language

Country of Birth *

For Non-U.S. Citizens Only

High School Information

High School Name *

Expected Graduation Date *

High School Address *

Address Line 1

Address Line 2

City

State

Zip Code

High School Phone *

Official Transcripts

Click or drag a file to this area to upload.

College or University Information

Name of College or University *

What is your planned major?

Are you currently or have you ever been charged with or subject to disciplinary action for scholastic or any other type of misconduct at any educational institution? *

If yes, please explain

If your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any risk of disciplinary action or revocation of your offer of admission.

Have you ever been charged with a violation of the law which resulted in, or if still pending could result in, probation, community service, a jail sentence, or the revocation or suspension of your driver’s license (including traffic violations which resulted in a fine of $200 or more?) *

If yes, please explain

Extracurricular, Personal and Volunteer Activities

Extracurricular Activities *

List your organizations, position, description of the activity, and hours per week of involvement.

Talents and Awards

List each, a description, the level, and number of years of involvement.

Community Service Work

List the type of work, your role, and hours per week of involvement.

Employment

List the job, your title, description, hours per week, and dates of employment.

Tell us your why *

Explain why you feel you should be awarded the LGBTQ+ Scholarship.

Resume

Click or drag a file to this area to upload.

Letters of Recommendation *

Click or drag files to this area to upload. You can upload up to 2 files.

Parent Information

The information requested below is optional, but it may assist in the review of your admission. You are strongly encouraged to complete this section.

Father or Legal Guardian Occupation

Father or Legal Guardian Education

Mother or Legal Guardian Occupation

Mother or Legal Guardian Education

Please indicate your family’s gross income for the most recent tax year. Include both taxed and untaxed income.

Photo and Image Release

I agree to allow my words and photographs to be used and appear in marketing materials, websites, and promotional materials produced by or for Puzzle Pieces Marketing. All rights to the marketing and promotional materials shall be Puzzle Pieces Marketing’s sole and exclusive property. I understand there is to be no compensation for words, photographs or video appearances in the above-mentioned media.

Puzzle Pieces Marketing shall have the right and may grant to others the right to disseminate print and publish my name and likeness in connection with the promotion of the ads, publications, or videos. I hereby release and discharge Puzzle Pieces and its respective agents, employees, successors, assigns and licenses from any and all claims, liabilities and obligations of any kind or nature which may arise from my appearance or participation in the ads and/or videos or any exhibition thereof.

Photo of Yourself 📸 *

Click or drag a file to this area to upload.

I hereby release all rights and waive any royalty and any other compensation with regard to usage of my photos *

Yes, I grant my persmission.

Agreement

I understand that I am bound by Puzzle Pieces Marketing concerning application deadlines and submission requirements. I agree to the release of any transcripts. I certify that this information is complete and accurate.

Do you understand and agree to the terms listed above? *

Yes, I understand and agree to the terms listed above.

Save and Resume Later

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Save and Resume Later

Your application has been saved and a unique link has been created which you can access to resume this application.

Enter your email address to receive the link via email. Alternately, you can copy and save the link below.

Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.

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Email *

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