Applicant Contact Information

First Name *

Last Name *

Phone *

Email *

Gender *

Date of birth *

Address

Street Address *

City *

State *

Postal code *

Academic Record Submission

Current Report Card With At Least 3 Marking Periods *

Current report card with at least 3 marking periods

Letter Of Recommendation From A Faculty Member *

Letter of recommendation from a faculty member

Name And Address Of The School You Plan To Attend: *

Current High School, Name and Address (if applicable):

Parent Or Guardian Contact Information

Primary Parent Or Legal Guardian Name: *

Primary Parent Or Legal Guardian Phone (if different): *

Primary Parent Or Legal Guardian Address (if different from yours): *

Additional Parent Or Additional Legal Guardian Name:

Additional Parent Or Legal Guardian Phone (if different):

Additional Parent Or Additional Legal Guardian Address (if different from yours):

Scholarship Essay

Provide (250 - 500 words) answering the following questions

Question 1 - Scholarship Justification *

Question 2 - Resilience and Growth *

Question 3 - Engagement and Contribution *

Limousine Company you or your family member is associated with *

Application Terms

Statement of Accuracy - Confirmation *

I hereby affirm that all the above stated information provided by me is true and correct to the best of my knowledge. I also consent that, if chosen as a scholarship winner, my photograph may be taken and used to promote the scholarship program. (Winner may waive photo due to unusual or compelling circumstances.) I hereby understand I will not submit this application without all required attachments and supporting information. Incomplete applications or applications that do not meet eligibility criteria will not be considered for this scholarship.

I agree to terms & conditions provided by CTANJ. By providing my phone number, I agree to receive text messages from CTANJ.