Super Scholars Student Bio Form

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Congratulations on being selected as a Super Scholar recipient.

Please note that this is not an RSVP to the event. The information will help us to create an introduction for you at our banquet.

* Required

Student Information

Student Name*

Preferred Pronouns*

High School*

Home Address*

City*

State*

Zip*

Email Address*

Phone*

Parent or Guardian 1

Name*

Phone*

Email Address*

Relationship to Student*

Parent or Guardian 1 Address Same as Student

Home Address*

City*

State*

Zip*

Parent or Guardian 2

Name*

Phone*

Email Address*

Relationship to Student*

Parent or Guardian 2 Address Same as Student

Home Address*

City*

State*

Zip*

Educator/Mentor

Please name the educator/mentor who has had a positive influence on your education. (They will be invited to attend the banquet as your guest.)*

Educator/Mentor Email Address*

School Where Educator/Mentor Taught You*

Educator/Mentor School Address (If Different Than Your Current School)*

City*

State*

Zip*

Other Student Info

List Your Top 3 Notable Achievements/Awards (250 Chars Max)*

What Are Your 3 Main Interests Outside of Academics? (i.e., extracurricular activities, hobbies, etc.) (250 Chars Max)*

What Career Plans Are You Have/Are Considering? (250 Chars Max)*

Which University/College(s) Are You Planning To Attend? If Undecided, List Top 3 Preferences.*

Dietary Restrictions

Are there any dietary restrictions of which we should be aware?

Student*

Yes (Please Describe Below)

Describe Dietary Restrictions

Guest 1*

Yes (Please Describe Below)

Describe Dietary Restrictions

Guest 2*

Yes (Please Describe Below)

Describe Dietary Restrictions

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Super Scholars Student Bio Form

Please complete the entire form and click the submit button.

Congratulations on being selected as a Super Scholar recipient.

Student Information

Parent or Guardian 1

Parent or Guardian 2

Educator/Mentor

Other Student Info

Dietary Restrictions

Thank you for your submission!