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? *