Scholarship Application To apply please complete the form below. Questions can be directed to Kathy Hixon - 704-602-9509 Nominee* First Last Home Phone*Email* School* Grade*Please enter a number from 8 to 12.Mother's Work Email Mother's PhoneFather's Work Email Father's PhoneHome Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Principal Name* Principal PhonePrincipal Email Athletic Director Name* Athletic Director PhoneAthletic Director Email Grade Point Avg. Weighted*Grade Point Avg. Unweighted*SAT and/or ACT Score*Part IIPlease provide two written references (i.e. coach, teacher, community person, etc) and send to Kathy Hixon - email: [email protected] or fax: 704374-9403Athletic Participation/ Awards*School Activities*Community Activities*College Aspirations/ Plans*Hood Hargett Breakfast Club – Liz Murray Scholarship Fund, PO Box 30127, Charlotte, NC 28203 Contact: Kathy Hixon Phone: 704.602.9509 Fax: 704.374.9403 Email: [email protected] www.hoodhargettbreakfastclub.com ** Hood Hargett Breakfast Club agrees to keep all information provided by applicant confidential ** Criteria for Scholarship: Must be a senior and must attend a school in the Charlotte Mecklenburg School SystemNameThis field is for validation purposes and should be left unchanged.