Encl (1) to COMDTINST 1780.1
DEPARTMENT OF
TRANSPORTAION
U.S. COAST GUARD
CG-5687 (11/01)
CGES SCHOLARSHIP PROGRAM APPLICATION
PERSONAL INFORMATION
Name:
Birth Date:
Address:
Phone: (
)
Parent or Guardian:
SSN#:
(Print)
Circle applicable category: Coast Guard Active Duty / Reserve / Auxiliary / Civilian
Duty Station/Work Location:
(Print)
Daytime Phone No.: (
)
HIGH SCHOOL INFORMATION
School Name:
Phone: (
)
Address:
High School transcript enclosed
Y
N
S.A.T. or A.C.T. scores included on transcript
Y
N
If not, have testing agency forward the scores directly to the CGES Scholarship Committee.
Intended College Name & Address:
HIGH SCHOOL EXTRACURRICULAR ACTIVITIES
1
Previous Page
