A Registered 501(c)3 Public Charity

Tivey-Lewis Scholarship Application

Your Name

Phone

Email address

Address

City

State

Zip

GPA

Awards, honors, and community service

Briefly tell us about yourself and explain how you would benefit from this scholarship award: (200-500 words)

Letter of Reference from a non family member

  • Reference Name:
  • Reference Letter (doc/docx/txt/rtf/pdf file formats OK):