Augsbury/North Country Scholarship - Student Self Nomination

Student Information

First Name*

Preferred First Name

Middle Initial

Last Name*

Date of Birth*

Email Address*

Cell/Mobile Phone Number*

Mailing Address*

Country

Street

City

Region

Postal Code

High School/College Information

(You can search for your high school by school name, the city where it's located, or its CEEB code. After you choose your high school from the drop-down menu, the CEEB code should fill itself in.)

High School*

CEEB

Cumulative GPA must be a 90 or higher for all New York State nominees through 11th grade (or 80 or higher for nominees from Canadian high schools). Please upload your unofficial transcript with your cumulative GPA through the end of the 2023-24 academic year included.*

Enrollment Information

When are you planning to start college?*

Are you interested in applying Early Decision?

Academic Interest

Additional Academic Interest

High School Counselor Information

First Name*

Last Name*

Email Address*