Note: This form is for Arizona and some Colorado teen drivers only. For other states, please visit our home page and navigate to your state. Thank you! Colorado Springs, Falcon, Fountain & Canon City, Colorado students should visit this page.

Jiffy Lube® Teen Driver Scholarship Application

2011-2012 Arizona and Colorado Teen Drivers

Durango, Cortez, CO and Payson, Show Low, Snowflake, Flagstaff, and Prescott Valley, AZ

Please fill out this application, attach your Essay as a Word document, text file or Rich Text File.

Deadline for submissions is March 26, 2012

Name
Address
City
State
Zip
Phone (include area code)
Cell Phone (include area code)
Email
High School
Grade (select current year) 10 11 12

Now it’s your turn! Get our attention! Tell us about your goals, drive, ambition … your future!

Simply write your 500-word typed Essay about what drives you now and attach it below by browsing your hard drive to find your Essay document.

The following factors will be considered for selection:          

  • Unique idea(s), invention(s), problem solving solutions
  • Personal  interests, goals, drive, ambition
  • originality, creativity, imagination and enthusiasm                   
  • Comprehensiveness, persuasiveness
  • Passion for higher learning
  • Pursuit of entrepreneurial endeavors

Please note: You MUST include the following at the top of your Essay document:

First Name, Last Name
Year in School (10, 11, 12)
School Name
State
Email
Home Phone
Cell Phone
Attach your Essay (.doc, .txt and .rtf files accepted - 1.5 Mb max size)

Accept Rules *
 I have read the eligibility rules and guidelines and understand that if selected as a finalist, I must return a signed image/talent release form for a minor (if under the age of 18) by a parent/legal guardian or if I am 18 years old a release form signed by me in order to be considered and selected as a Jiffy Lube scholarship award recipient.

If you encounter problems with this form call our technical support supervisor, Steve, at 801-671-6420 or email at steve@cohezion.com.

 

 

Jiffy Lube, the Jiffy Lube design mark and Jiffy Lube Signature Service® are registered trademarks
of Jiffy Lube International, Inc.

© 2006-2012 The Ostler Group — All Rights Reserved.