Name *

Email *

Phone *

Current High School *

County of Residence (please select) Santa Barbara Ventura San Luis Obispo

Graduation Date *

Amateur Radio Callsign (if any)

Current GPA *

Extra Curricular Activities *

Have you already been admitted to a college or university STEM program? *

• Yes
• No

Plans for next school year including your intended course of study? *

What are your goals after college or university? *

How will this scholarship help you achieve your goals? *

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