A. LOIS HIGHTOWER-JACKSON, INC.

(A Missouri non-profit corporation) P.O. Box 414162 Kansas City, Missouri 64141 816 833 6744

SCHOLARSHIP APPLICATION

Applications must be submitted no later than December 31, 2026 at 11:59PM CT.

Scholarships are limited to high school seniors living in the Kansas City vicinity including Missouri counties of Jackson, Clay, Cass and Platte, and Kansas counties of Wyandotte, Johnson, Douglas and Leavenworth.

Name of Applicant

Address

Applicant Phone Number

Applicant Email Address

Name of Contact Parent(s)/Adult

Contact Parent(s)/Adult Phone Number

Contact Parent(s)/Adult Email Address

Number of siblings/other family members under age eighteen who also reside in your household:

Annual net gross income of household:

Name and location of High School:

High School Grade point average:

What degree or field of study will you pursue?

List of extracurricular school/civic/church activities:

How will receiving this scholarship help in achieving your goals? (min 250 words)

Signature

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