CEB Scholarship Registration Form

Please fill out the information below in order to complete the registration portion of your application. Please answer honestly, to the best of your knowledge.

Student's Name

First Name

Last Name

Parent's Name

CPS Employee

First Name

Last Name

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Phone

(###)

###

####

Household Income

High School Senior?

Currently enrolled as a full-time student.

Yes

High School Name

School Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

School Phone

(###)

###

####

Current GPA

High School Graduation Date

YYYY

List Colleges You've Applied To

List School and/or Community Involvement, if any

Questions about the CEB scholarship fund should be directed to: CEBscholarship@consumerportfolio.com