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? *