Door County 2015 Common Scholarship Application

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1 1. APPLICANT S FULL NAME: Door County 2015 Common Scholarship Application The Door County Common Scholarship Application is designed to simplify the scholarship application process for Door County students. Download this application, save a copy to your computer, and edit it as often as needed. Submit this application to scholarship programs which accepts this common application. Note that some scholarships require additional materials such as letters of recommendation or a unique essay in addition to this common application. Also note that NOT every scholarship program accepts the Door County Common Scholarship Application. Please review the instructions of each individual scholarship to be sure you re submitting the correct application and information. SCHOLARSHIP FOR WHICH YOU ARE APPLYING: 2. APPLICANT INFORMATION Mailing Address: City, State, Zip: Door County Resident: Yes No Resident of the City, Village or Town of: Telephone: High School: Month & Year of Graduation: 3. PARENT INFORMATION Father s Name: Occupation: Employer: Telephone: Mother s Name: Occupation: Employer: Telephone: Parent s Marital Status: Married to each other Divorced from each other Never married to each other Widowed Both deceased With whom do you primarily reside: With both parents Mother s home Father s home Independent Guardian (Name and Relationship: ) 4. CERTIFICATION I declare under penalty of perjury that all statements contained in this application and any accompanying documents are true and correct to the best of my knowledge. (Parent/Guardian signature required if applicant is claimed as a dependent for tax purposes). Applicant s Signature Date Parent s or Guardian s Signature Date

2 5. HIGH SCHOOL ACADEMIC PERFORMANCE Cumulative Grade Point Average: Class Rank: Class Size: Does your high school use a weighted GPA (such as for honors or advanced placement courses): Yes No Number of Advanced Placement, Honors, or Advanced Courses: Senior Year: Junior Year: ACT Composite: SAT Critical Reading: SAT Math: SAT Writing: Include all scores if you have taken both exams. 6. COLLEGIATE ACADEMIC PERFORMANCE (if currently enrolled in college) College: Month & Year of Graduation: Cumulative Grade Point Average: Class Rank: Class Size: If applicant s college uses a weighted scale or anything other than a 4 point scale, attached a separate sheet explaining system. 7. SIGNIFICANT CO-CURRICULAR ACTIVITIES (clubs, sports, student government, etc.) Co-Curricular Activity Leadership Position (if any) Hours/Month Years Involved 8. SIGNIFICANT COMMUNITY VOLUNTEERISM (church, charity work, scouting, etc.) Volunteer Activity Leadership Position (if any) Hours/Month Years Involved

3 9. SIGNIFICANT PERSONAL INTERESTS AND HOBBIES Personal Interest or Hobby Hours/Month Years Involved 10. SIGNIFICANT SCHOOL OR COMMUNITY AWARDS Award Awarded By Years Awarded 11. STUDENT WORK EXPERIENCE Most recent employer: Job Title: Average Hours/Month: Hourly Wage: $ From (month/year): To (month/year): Next most recent employer: Job Title: Average Hours/Month: Hourly Wage: $ From (month/year): To (month/year): 12. COLLEGE INFORMATION Anticipated Undergraduate Major or Program of Study: Type of School: Four-Year College or University Technical or Community College Junior College Other (Please specify: ) Level of Attendance: Full-Time Part-Time 1 st choice or If applicable, current school: 2 nd choice school: City, State: City, State: Next year s anticipated expenses at this school: and at 2 nd choice school, if applicable: Tuition: $ Tuition: $ Room & Board: $ Room & Board: $ Books & Supplies: $ Books & Supplies: $ Total: $ Total: $

4 13. FINANCIAL INFORMATION Percentage of college expenses to be paid by: You % Father % Mother % Other % (please explain: ) Do you plan to live on campus? Yes No Do you plan to work while attending school? Yes No Ages of siblings living at home: Ages of siblings attending college next year: List all scholarships, grants or awards (including dollar amounts) that you know you will receive for next school year: Briefly explain any unique financial circumstances: 14. PERSONAL STATEMENT In the space provided, briefly discuss your post-secondary educational plans and possible career goals. 15. PERSONAL ESSAY In the space provided, select a person you admire, describe why you admire this individual, and how he or she has influenced your life. 16. SUPPORTING DOCUMENTS The following documents must also be submitted with this application: Official high school transcript, verifying GPA, class rank, and test scores. If already attending college, submit your college transcript and current course schedule. Copy of your Free Application for Federal Student Aid (FAFSA) Student Aid Report (SAR). If your SAR is not yet available, submit a copy of your FAFSA Application.

5 17. ADDITIONAL INFORMATION Please refer to the instructions of each individual scholarship program to determine if it requires additional information or other documents. If additional information is required (such as an essay, an explanation of volunteer work, etc.), you may attach additional pages or simply provide the information in the space below. The Door County Scholarship Network is a program of the Door County Community Foundation, Inc. The Door County Common Scholarship Application was created to simplify the application process for students. This application will be submitted to independent third-party scholarship programs of your choosing. The actions of such independent scholarship programs is not within the control of the Community Foundation, and thus the Community Foundation cannot and will not take responsibility for their actions and does not take responsibility for the collection or use of personal data by any independent third-party scholarship program.

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