Presidential Diversity Scholarship
Online Nomination Form - For Counselor Use Only
 
    * required field
  Counselor Information  
  *Counselor Name
  Counselor Title
  * High School / Community Organization
  *Counselor Email Address
     
  Nominee Information  
  * First Name
  * Last Name
  Gender Female
Male
  Race
  * E-Mail Address
  * Mailing Address
   
  * City
  * State
  * Zip
  *High School
  *High School Graduation Year
     
  Please describe briefly why you are nominating this student for the Presidential Diversity Scholarship: