Application for Scholarships

APPLICATION FOR SCHOLARSHIPS

Administered by

ALLEGANY COUNTY AREA FOUNDATION

Part I: Personal Information:

Last 4 digits of Social Security # ____

High School _____________________

Name:

Please print or type _______________________ Phone _________

Legal Address:

Street Address: _________________________

Town: _________________________

e-mail: _________________________

Legislative District: I, II, III, IV, V (please circle)

Township:

Graduation Date:

College you plan to attend next year:

College now attending:

College graduation date:

College major anticipated:

Name of parent(s) or guardian(s) with whom you reside:

List full or part-time employment

Employment:

Dates:

List special recognition, honors, scholarships, or awards you have received:

List extracurricular and community or volunteer activities (clubs, organizations, memberships, athletics, offices held, projects):

Part II: Financial Information:

Applicants must submit a copy of the page of their parent's Federal Income Tax Return showing "Taxable Income" or the student's FAFSA form. Social Security numbers may be blackened out. (Only students who qualify as independent students under federal guidelines may claim financial independence.)

Part III: Estimated College Expenses (annual basis)

Tuition and Fees:_____________________

Room and Board__________________ Other__________

How do you plan to meet these expenses:

Detail any unusual circumstances which affect your need for financial assistance:

Part IV: Essay

Essay must be typed and be no more than 400 words in length.

Name someone in your school career who has made a positive influence on your life (teacher, non-teacher, staff member, administrator or any school employee considering grades K-12 or college personnel) and describe the contribution he/she has made. No family member please. Only home-schooled students may nominate a non-school employee.

Each scholarship recipient and the subject of his or her essay will be honored by the Foundation. Make sure you include the nominee’s name, phone number and full mailing address. Make sure the quality of your essay is exemplary…….content, spelling, etc.

Part V: Letters of Recommendation

One letter of recommendation should be from a person who knows you well (administrators, teachers, employers, community leaders or clergy). Please list reference: (No family members please)

Part VI: Transcript

An official transcript must include grades from the first semester of the current school year.

Part VII: Affirmation

I hereby affirm that the information herein is correct, and I promise to notify the Allegany County Area Foundation, Inc., immediately of any significant change. I agree that any award made to me may be revoked or changed.

I acknowledge that payment of a renewable scholarship will not be made unless I submit proof of a 2.5 or above cumulative average within 60 days of the end of the semester, plus the required self-addressed, stamped envelope. I understand that essays may be shared at various events as well as published in the Foundation’s Annual Report.

Date____________________

Signature_____________________________

Checklist

_____This Application

_____IRS return(s) if required

_____400 word essay

_____One letter of recommendation

_____Official Transcript