If you are interested in being considered for a Bill Dickey Scholarship, please complete the form below.

    FIRST NAME *

    MIDDLE NAME *

    LAST NAME *

    DATE OF BIRTH *

    ADDRESS *

    CITY *

    STATE *

    ZIP *

    MEMBER OF FIRST TEE? *

    yesno

    FIRST TEE CHAPTER

    NAME OF SCHOOL *

    USGA HANDICAP ID

    GRADUATION YEAR *

    ARE YOU MALE OR FEMALE? *

    ETHNICITY *

    African AmericanHispanic/ChicanoAsian/Pacific IslanderAmerican Indian/Alaskan NativeOther (please specify in next field)

    IF YOU SELECTED OTHER ETHNICITY, PLEASE SPECIFY

    GPA *

    GRADE *

    HANDICAP *

    AVERAGE SCORE *

    PARENT/GUARDIAN NAME *

    PARENT/GUARDIAN MOBILE # *

    PARENT EMAIL ADDRESS *

    JUNIOR GOLFER EMAIL ADDRESS *

    IN WHICH STRUCTURED GOLF PROGRAMS HAVE YOU BEEN ACTIVE? *

    LIST YOUR TOURNAMENT ACCOMPLISHMENTS *

    WHAT AGE DID YOU START PLAYING GOLF? *

    ARE YOU INTERESTED IN A GOLF SCHOLARSHIP? *