1. The due date is:
      2. · ALL INFORMATION PROVIDED ON THIS FORM WILL BE TREATED AS CONFIDENTIAL.

      Application for Scholarships & Scholastic Awards

      2014-2015



       


      The following questionnaire will provide the Scholarship Committee with information needed for providing nominations and scholastic awards to seniors.

       
      ·
       
      All sections of this application must be completed (including financial information) for you to be considered for scholarships.
      ·
       



      The due date is:

      · Submit your application to:
      · Completion of this form does not guarantee that you will receive any scholarship money.



      · ALL INFORMATION PROVIDED ON THIS FORM WILL BE TREATED AS CONFIDENTIAL.
       
       
      Section 1 – Personal Information
       
      Name (please print clearly):
      Student ID #: Social Security #:
      Address:
      Home Phone: Your Cell Phone:
      Your E-Mail Address:
      Highest SAT/ACT Score: Cumulative GPA as of June 2013:
       
      Section 2 – Higher Education Plans
      List, in order of preference, any four-year colleges/universities to which you intend to apply:
      1.
      2.
      3.
      4.
      If known, your intended major/interest:
      List, in order of preference, any community college or technical/vocational school to which you may apply:
      1.
      2.
      3.
      4.
      If known, your intended area of concentration:
       
      Section 3 – Financial Plans
      How do you or your family plan to fund your post-high school education?
       
       
       
       
       
       
       
      Section 4 – Family Financial Information



      CONFIDENTIAL – for Scholarship Committee members only
      This information is very important for you to be considered for any “need”-based scholarships, and applies to the person(s) legally responsible for your financial welfare (your parents, foster parents, or other legal guardians).
      Student resides with: [ ] Mother and Father [ ] Single Parent
      [ ] Other: # of Individuals in Family:
      Father’s Name:
      Occupation:
      Yearly Gross Salary: [ ] under 30,000 [ ] 30,001-50,000
      -50,001-75,000 [ ] 75,001-100,000 [ ] over 100,000
      Mother’s Name:
      Occupation:
      Yearly Gross Salary: [ ] under 30,000 [ ] 30,001-50,000
      [ ] 50,001-75,000-75,001-100,000 [ ] over 100,000
      Number of persons living in the home who are dependent upon this income (including yourself):
      Adults: Children (include ages):
      Are any of your brothers/sisters currently attending college? [ ] Yes   [ ] No
      Please complete the FAFSA4CASTER online now at FAFSA.ed.gov, then enter your EFC (Estimated Family Contribution) here:
       
      Section 5 – Special Circumstances
      If you wish, describe any unusual or special circumstances that may make financing your post-high school education a hardship (such as hospital bills, disabled parent, you are self-supporting, etc.) Continue on other side or additional page if necessary.
       
       
       
       
       
       
       
       
       
      Section 6 – Additional Information
      Please complete as much of the following as is applicable. Continue on other side or additional page if necessary.
       
      Honors/Awards/Leadership
      Description
      Your Grade Level
      Extra-Curricular Activities
      Description
      Your Grade Level
      Community Involvement (non-school-related)
      Description
      Your Grade Level
      Employment Experience
      Description
      From Date
      To Date
         
         
         
        
      Significant Travel
      Description
      From Date
      To Date
         
         
         
         


       


      Section 7 – Statement & Signature

      “I have read the statements in this application and I certify that, to the best of my knowledge, they are true .”

       

      Student Signature:     Date:

       





      When completed, please return this form to:

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