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Henry Clay Senior Transition and Scholarship Form 2021
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Student Last Name *
Student First Name *
Student Middle Name
Street Address
City, State, Zip
Guardian 1 Work Phone Number
Guardian 2 Work Phone Number
Student's Cell Phone Number
Current Guardian email
Current Home Phone
Student's email next year
Date of Birth
MM
/
DD
/
YYYY
Gender
Clear selection
Facebook Name - used to contact you through FB messenger; we will not friend you.
Race
Clear selection
What do you plan to do after graduation? *
Check all that apply and then for any that you check, add descriptors below.
Required
If you chose Go to School
First Choice School Name
First Choice School Type
Clear selection
First Choice School Location
Clear selection
Second Choice School Name
Second Choice School Type
Clear selection
Second Choice School Location
Clear selection
If you chose Find a Job
First Choice Job Company Name
First Choice Job Location
Clear selection
Second Choice Job Company Name
Second Choice Job Company Location
Clear selection
If you chose Join the Military
Branch
Clear selection
If you chose Other
Please Describe
Please give the name and number (other than the number above) of someone who will know how to reach you this fall.
If you did not choose Go to School above, you are finished and can submit your survey.  If you did choose Go to School, please answer the following questions regarding ALL colleges to which you were accepted and ALL scholarships you earned.  
There are six spots for individual entries, plus one for any additional.  If you do not have answers for all of those fields, leave the extras blank.
College Name 1 - PLAN TO ATTEND
College Name 2 - accepted
College Name 3 - accepted
College Name 4 - accepted
College Name 5 - accepted
College Name 6 - accepted
Additional College Names - accepted
Scholarships Awarded - please read instructions
If it is from a College or University, list the name of the School.  If it is from an outside group, list the name of the Scholarship.  Make sure to include your KEES award.  Also, indicate the amount of the Scholarship, if the award is one-time or renewable yearly and if you are accepting it or not.
Scholarship Name 1
Scholarship 1 Amount per year (do not include dollar sign)
Scholarship 1 Type
Clear selection
Scholarship 1 Status
Clear selection
Scholarship Name 2
Scholarship 2 Amount per year (do not include dollar sign)
Scholarship 2 Type
Clear selection
Scholarship 2 Status
Clear selection
Scholarship Name 3
Scholarship 3 Amount per year (do not include dollar sign)
Scholarship 3 Type
Clear selection
Scholarship 3 Status
Clear selection
Scholarship Name 4
Scholarship 4 Amount per year (do not include dollar sign)
Scholarship 4 Type
Clear selection
Scholarship 4 Status
Clear selection
Scholarship Name 5
Scholarship 5 Amount per year (do not include dollar sign)
Scholarship 5 Type
Clear selection
Scholarship 5 Status
Clear selection
Scholarship Name 6
Scholarship 6 Amount per year (do not include dollar sign)
Scholarship 6 Type
Clear selection
Scholarship 6 Status
Clear selection
Additional Scholarship Information
Thank you for taking your time to complete this survey!  
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