Jiffy Lube Teen Driver Scholarship Application

Note: This form is for Utah teen drivers only. For other states, please visit our home page and navigate to your state. Thank you!

Jiffy Lube® Teen Driver Scholarship Application

2011-2012 Utah Teen Drivers

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

Home Phone (include area code)

Cell Phone (include area code)

High School

Grade (select current year)

10 11 12

Now it’s your turn! Get our attention!

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

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.

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of Jiffy Lube International, Inc.