Gary Wusterbarth Community Service Scholarship FORMsgwibca2024-10-31T13:14:58-07:00

Gary Wusterbarth Community Service Scholarship Award Form

Name *

First

Last

Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date of birth *

Graduation Date *

School Name *

School Address *

Address Line 1

Address Line 2

City

State

Zip Code

High School Coach

High School Athletic Director

Sports you participated in

Basketball Awards/Accomplishments

College or University you are attending

Application Procedure:

1. Submit application by deadline
2. ALL documents must be submitted through this web form:

Photos of you (Headshot) upload

Drag & Drop Files, Choose Files to Upload

JPG and PNG format allowed (max file size: 3mg)

Essay & letter of recommendation upload

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Allowed files are txt,pdf,doc,docx (max file size: 5mg)