Bellator Titans MC
City, ST, ZIP
Father’s Name: ___________________________ _ Occupation: _____________________________
Mother’s Name: __________________________ _ Occupation: _____________________________
Current High School Information
Name: __________________________________ _ City: ________________ State: _________ Zip: ________
GPA (4.0 Scale):_______ Class Rank: _________
Principal Name_____________________________ Counselor Name: _________________________________
School Planning to Attend
Name: ___________________________________ Area of Study: ___________________________________
Address: __________________________________ City: _________________ State: _________ Zip: ________
Essay Question: (500 Words) please select one question to answer on separate page.
1. Please Describe a time in your life in which you had to overcome adversity.
2. Please explain how your life experiences have prepared you for life after high school.
Extracurricular Activities and Hobbies
Please list the extracurricular activities you have been involved in during your high school career and hobbies you actively participate
Summarize your volunteer and/or charity experience.
Are you currently enlisted or perusing any armed forces? __________ What Branch? _____________________________
Reference Information (Please attach Letter of Recommendation, or have Reference send to address)
Name Email Relationship to
Agreement and Signature
By submitting an entry for the Bellator Titans MC Scholarship, I certify that the statements contained in this application packet are
true, accurate, and complete. I understand and agree that any scholarship funds received will be distributed directly to my postsecondary institution upon verification of enrollment. I also agree that this entry becomes the property of Bellator Titans MC, and
my name and photo may be released to the public and news media.
Required Materials: Photo of Applicant
Letter of Recommendation
Application Deadline: March 13th, 2020
Send Applications to: BTMC Scholarship Committee
Attention: Roger Moeller
508 David Ave
Baltic SD, 57003
Thank you for completing this application. The Bellator Titans MC is dedicated to our local communities and
area students. We are a charity motorcycle club and participate in raising money by hosting and participation
in poker runs for various charities as well as volunteering our time for our communities. For more information
please contact Roger Moeller at email@example.com
Bellator Titans MC