Name (Last, First, MI): __________________________________________________________________
Current Address: _______________________________________________________________________
Current City/State/Zip: __________________________________________________________________
Permanent Address (if different from current): _______________________________________________
Permanent City/State/Zip (if different from current): __________________________________________
Name and City of School You Attend or Will Be Attending: _____________________________________
Are you a U.S. citizen or otherwise authorized to work in the United States?
Telephone Number: __________________________________
E-mail Address: ______________________________________
Schools (HS,
College, Grad)
City/State Dates Attended Degree/Major (if
Date of
Current or Expected Major(s): ____________________________________________________________
Highlight honors or awards that you have received:
What is your involvement in extracurricular activities or volunteer work?
What are you planning to study and what kind of career are you planning to pursue?
Is there any other relevant information you want us to consider when reviewing your application?
Please tell us how you learned about our scholarship program.
Please submit a 300-500 word essay based on our writing prompt:
There have been many public service campaigns about the dangers of drinking and driving; however,
people continue to drink and get behind the wheel. Write an essay about the reasons why people
continue to drink and drive - and what initiatives could be executed to address those reasons.
Please attach your essay as a separate document.
I hereby certify that the information I have provided on this application form and on any of the attached
materials is true to the best of my knowledge. The essay is my own work and has not been duplicated or
printed elsewhere. I understand that if I am awarded the scholarship, my winning essay will be posted
on Worgul Law Firms website.
Applicant Signature: _________________________________________________________________
Full Name of Applicant (printed): _______________________________________________________
Date: __________________, 2019
Return completed application and requisite materials by email to:
Questions regarding our scholarship opportunity? Please, no phone calls. Email only.
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