Date of Application *

First Name *

Last Name *

Date of Birth *

Home Address *

(street, zip code and state)

Email *

Name of PHCC of NC member company sponsoring you for this application: *

Member Company address: *

Member Company phone number: *

Your relationship to the company: *

Previous School: *

What high school, trade school, or program did you attend last year?

Date of Graduation or GED: *

Current Enrollment: *

High School

College/University

Trade School

Apprenticeship Program

What college, university, trade school, or registered apprentice program do you plan to attend? *

Have you been accepted? *

Yes

No

What course of study do you plan to follow? *

Transcript Request: *

Please attach a transcript from your current school, College/University, trade school, or apprenticeship to complete your application.

For those in a trade school or apprenticeship program, this can include:

• Proof of enrollment
• A record of completed courses, certifications, or training hours
• A progress report or evaluation from your program supervisor

If you have questions about what documentation to submit, please contact Adria Jones [email protected].

20MB max

List extracurricular activities and honors received through school, workplace, church and community *

Letter of intent: *

20MB max

Resume *

20MB max

Letter of recommendation 1 *

Applicants must provide three (3) letters of recommendation including a letter from your high school principal/counselor, college or university dean or academic advisor.

20MB max

Letter of recommendation 2 *

20MB max

Letter of recommendation 3 *

20MB max

Contact Information for Award Ceremony Invitation *

If you are selected as a scholarship recipient, who would you like us to contact to invite to the award ceremony during our Summer Convention at Carolina Beach on August 8, 2026? There is no cost for you or your guests to attend the ceremony.

• Name: 
• Relationship to You: 
• Phone Number: 
• Email Address:

Signature *