R.A .C. Scholarship App.


Due April 1

Send to

R. A. Clement Scholarship Application


P. O. Box 70

Cleveland, N. C.   27013


Instructions:  Please complete this application and attach a copy of your high school transcript and a small picture of your self.  Your application will be reviewed by the Scholarship Committee of the R. A. Clement Association.  Awards will be given on the basis of need, academic achievement and level of school and community involvement.


NAME _______________________________________________________________________________


ADDRESS ____________________________________________________________________________


CITY _________________________________STATE______ZIP______PHONE____________________


EMAIL _______________________________________________________________________________


High School _________________________Location___________________Graduation date___________


Extra Curricular Activities (School and Community)


Organization                                                                                         Offices held/honors






Name of Parents or Guardians _____________________________________________________________

Occupation ______________________________No. of sisters and brothers _________________________

Family member(s) who attended R. A. Clement _______________________________________________

Relationship ___________________________________________________________________________

Immediate family members who attended College:



College(s)  you  have applied to                                                                                       Accepted,check here






Signature _________________________________________________Date_________________________


*****Please use a separate sheet to explain your career goals and how you will pay for college.


Which Scholarship are you applying for?

[   ].  R.A. Clement   ( This scholarship is only for student who are descendants  of former R.A. Clement students.)

 [.  ].  George C. Knox ( This scholarship is open to all students.)

[     ] William Hall Educational Scholarship ( Priority is given to students from Anson County who are pursuing an Education Degree)