High School Application | Phyllis Perry Hulton Educational Trust

Today's Date*

Name*

First Last

Age*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Additional items

Essay should be 150 word minimum discussing any personal information that you would like to share with the Perry Hulton scholarship committee relevant to your educational goals, volunteer work, paid jobs, motivational factors that influenced your decisions, or obstacles you have/are facing.

Transcript (Unofficial)*

Max. file size: 50 MB.

College Transcript

Max. file size: 50 MB.

PPH Scholarship Recommendation Form*

Max. file size: 50 MB.

Downloadable Form at Top of Page

Essay*

150-500 words

Max. file size: 50 MB.

Picture

Max. file size: 50 MB.

What high school will you graduate from?*

Anticipated Date of Graduation*

Current High School GPA*

How many college credits have you completed?*

Current College GPA*

How many college credits are you currently taking?*

Have you taken the ACT or SAT Test?*

If so, what was your best composite score?

What college or technical school do you plan to attend?*

Have you selected an area of major study?*

If yes, what?

Do you plan to work for part of you expenses?*

Do you have a physical disability?*

If yes, please explain and state how it has affected your abilities as a student.

Family

Father's Name

First Last

Phone

Employment

Address same as Student?

Yes

No

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mother's Name

First Last

Phone

Employment

Address same as Student?

Yes

No

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Stepmother's Name

First Last

Phone

Employment

Address same as Student?

Yes

No

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Stepfather's Name

First Last

Phone

Employment

Address same as Student?

Yes

No

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

References

List two adults as references (other than family member), preferably someone you have known for at least two years.

First Reference*

First Name Last Name

Phone*

Relationship*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Second Reference*

First Name Last Name

Phone*

Relationship*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parents & Stepparent's Adjusted Gross Income in 2025 (Located on 2025 tax return)*

Note: Please include Adjusted Gross Income on both parents tax return. If you haven’t filed your 2025 tax return please estimate or use Adjusted Gross Income from 2024.

If independent, please state your Adjusted Gross Income or you & your spouse in 2025*

Note: Independent means you are not a dependent on anyone else’s tax return and do not receive assistance for your education from a parent/guardian.

List student’s indebtedness in excess of $100*

Include any other educational loans.

Money Owed To

Unpaid Balance

Purpose of Loan

Please list names and ages of siblings or other persons dependent on your parents/guardians for financial support. If these are attending a college, university, technical or trade school, please write the names of the institutions.*

Name

Age

Educational Institution

Phyllis Perry Hulton Educational Trust Education Finance Planner

College/Technical School*

Anticipated Costs for Academic School Year 2026-2027

1. Tuition and Registration Fees*

2. Books and Supplies*

3. Room and Board*

4. Miscellaneous Living Expenses*

Clothing, entertainment, etc.

5. Medical*

6. Transportation (Travel)*

7. Other*

8. Total Estimated Expenses*

9. Money Parents, Stepparents Can Provide*

10. Money You Can Provide*

11. Other Scholarships*

Do not enter unless already awarded or student has a high probability of receiving one. Do not include Scholarship from Phyllis Perry Educational Trust.

12. Pell Grant*

13. Guaranteed Student Loan*

14. Total Lines 9-13*

15. Amount needed for Academic School Year*

Subtract Line 14 from Line 8

How do you plan to cover the deficit?*

FAFSA EFC information may be requested.

Applicant Signature*

By typing your name in this space you agree and understand by typing your name it is a legal equivalent of your manual/handwritten signature

Full Name