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2012-13 Uniform Application

This document is a uniform scholarship application containing background information about the applicant such as name, address, family details, academic record including GPA, class rank, ACT score, extracurricular activities, career goals, and financial information including estimated costs of attendance at potential colleges and plans to finance education. The applicant must submit the completed application along with a transcript and list of achievements to the scholarship committee by January 31 for consideration.

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Tyler Meyer
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46 views3 pages

2012-13 Uniform Application

This document is a uniform scholarship application containing background information about the applicant such as name, address, family details, academic record including GPA, class rank, ACT score, extracurricular activities, career goals, and financial information including estimated costs of attendance at potential colleges and plans to finance education. The applicant must submit the completed application along with a transcript and list of achievements to the scholarship committee by January 31 for consideration.

Uploaded by

Tyler Meyer
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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UNIFORM SCHOLARSHIP APPLICATION

Due to Mrs. Weiss by January 31, 2013


*Incomplete applications will not be considered
I. Background Information:
1.

___________________________ ___________________________ ___________________________


First name

Middle name

Last name

___________________________ ___________________________ ___________________________


Street

City, State

Zip code

___________________________ ___________________________ ___________________________


Email Address

2.

Telephone number

Date of Birth

_____

Name of parent(s)/conservator/guardians

_____

Address of above

3. List the names of siblings and the colleges they are attending:
Name(s)

College

_____
_____
_____
II. School & Community Information
4. Cumulative GPA __________ 5. Class Rank __________ 6. ACT Composite __________
7. To be completed by the office:
School year

Days Absent

Days Tardy

Explanation

Verified by: ______________

2009-10

__________

_________

__________________________________________________

2010-11

__________

_________

__________________________________________________

2011-12

__________

_________

__________________________________________________

2012-13

__________

_________

__________________________________________________

8. During the 2012-13 school year, what are your extracurricular activities? (include
additional pages if necessary)
A.
B.
C.
D.

E.
F.
G. ______________________________________________________________________________________
9. Please list any courses you have taken or will take for college credit during your high
school career:
College

Course

# of Credits

___________________________ ___________________________ ___________________________


___________________________ ___________________________ ___________________________
___________________________ ___________________________ ___________________________
___________________________ ___________________________ ___________________________
___________________________ ___________________________ ___________________________
III. Goals and Aspirations
10. State in your own words how you feel high school has prepared you for your major
course of study at a college, university, or other form of higher education.

11. State your career goal(s).

12. List the name(s) and location(s) of educational institution(s) you are considering.
A.

B.

C.

IV. Financial Information


13. Approximate cost of tuition, books, room, board, travel, & other expenses related to one
full year of education at the institutions listed in #13 above:
A.

B.

C.

14. Occupation and employer of your parent(s)/conservator(s)/guardian(s).

15. Was your familys adjusted gross income above / below $42,500 for the previous year?
(Circle one)

16. How do you plan to finance your education? (Please list percentages to the best of your
knowledge)
Parental Assistance

_________%

Savings

_________%

Loans

_________%

Work Study

_________%

Scholarships

_________%

Employment

_________%

Grants

_________%

Expected income

$_________

17. Have you done anything in addition to the above to plan for financing your education?

18. Employment record - list employers, dates of employment, and supervisors.


A.

B.

C.

V. References:
19. Name three people who will provide recommendations.
A.

B.

C.

20. Please attach:

a copy of your current transcript

a listing of your achievements, honors, elected positions, volunteer


positions, & service experiences
************************

In submitting this application, I understand that the information contained herein will be
treated confidentially and will be shared only with those people responsible for determining the
beneficiaries of the scholarships, awards, grants, and loans listed on the face of this application.
The information I have furnished is true and correct to the best of my knowledge and belief. I also
understand that any scholarships, grants, or awards I might receive are contingent upon my
maintaining substantially the same grade point average for my final semester.

___________________________________________________
Signature of Applicant

____________________
Date

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