THE ADRIAN M. SAMPLE SCHOLARSHIP TRUST APPLICATION

Size: px

Start display at page:

Download "THE ADRIAN M. SAMPLE SCHOLARSHIP TRUST APPLICATION"

Kathleen Paul
8 years ago
Views:

1 THE ADRIAN M. SAMPLE SCHOLARSHIP TRUST APPLICATION A. Minimum Requirements Student must be: 1. An active member of a Protestant Church (Pastor s recommendation required.) 2. A bona fide resident of St. Lucie County or Okeechobee County, Florida 3. Unmarried, unless a graduate student seeking a Master s Degree or higher. 4. Attending an accredited college or university in Florida or Davidson College in Davidson, N.C. High school students with less than a 3.00 GPA, and college students with less than a 3.00 GPA are not encouraged to apply. Further information may be obtained from Indian River State College Foundation or B. Student Information: This application and all required documents (see page 4), complete in every detail, must be postmarked by Monday, March 7, 2016 if consideration is to be given. Type or print in ink. 1. Name: 2. Home Address: Last First Middle Initial Street City State Zip 3. ( ) Telephone Date of Birth address 4. Sex Single Married Divorced Number of Dependent Children 5. Church Affiliation: Name of Church Church Address: Street City State Zip Pastor s Name: Church Telephone ( ) List church activities in which you participate: Attach a 2 x 2 inch (passport size) photo here 6. I will be applying for Financial Aid Assistance: yes no. I will be applying for a student loan: yes no. Total number of student loans, prior to new school year. 1

2 7. Still in high school: yes (Complete Section C). In college: yes (Go to Section D). If you have fewer than 30 college credits please answer questions in Section C and complete Section D. 8. Does either one of your parents have a Bachelor s Degree from an accredited College or University? yes no C. High School Students (and students with fewer than 30 college credits): 1. Name of high school Location 2. Date of graduation Numerical Class Rank Percentile Class Rank 3. Approximate, GPA ( ) SAT scores (verbal) (math) ACT score 4. Number of dual enrollment credits earned Where earned? 5. National Honor Society: yes no. Other awards or academic recognition: 6. Campus Activities/Community Service (indicate leadership positions) 7. College/University you will be attending for the academic year Location Major field of interest D. Undergraduate College/University Students (regardless of # of college credits earned): 1. Dependent on family (Complete Section F) Independent (Complete Section G) 2. Name of college/university Accumulated GPA Dates attended Credits attempted Credits earned 3. Undergraduate academic recognition: 4. Campus Activities/Community Service (indicate leadership positions) 5. College/University you will be attending for the academic year Will institution offer scholarship? Major Degree I am seeking Expected date of graduation Terminal degree (yes) (no) Other degrees I hold (year and awarding institutions): E. Graduate Students (beyond the baccalaureate): 1. Baccalaureate degree (BA) (BS) Institution Date earned Major Cumulative GPA 2. Master s degree: (yes) (no) Institution 2

3 Date Earned Major 3. College/University you will be attending for the academic year Major Degree I am seeking Reasons for seeking degree: Expected date of graduation F. Financial Information (students dependent on family): Information is CONFIDENTIAL. 1. I intend to work while in school (yes) (no) If yes: How many hours/week? Is having a job necessary? Explain: 2. I plan to have a vehicle in college If yes: Make Year Model Monthly payment Monthly insurance 3. Amount of my personal cash and savings: Value of my stocks, bonds, trust funds, gifts, etc. My 2015 income was 2016 Estimated income is Income Tax paid in Estimated Income Tax 4. My parents (family) will assist me financially while attending college? (yes) (no) If no, please explain My parents are: married divorced separated Number of dependent children living at home Their ages: Number of children in college next year? 5. Father s occupation 2015 Total income Estimated total income for Mother s occupation 2015 Total income Estimated total income for Income tax paid by parents Parent s Estimated 2016 Income Tax Parent s cash and savings: Total value of stocks, bonds, pensions, real estate (other than your homestead), IRAs, TSAs, 401Ks Market value of home Outstanding mortgage Year home was purchased If additional room is needed to better explain your finances, please use a separate sheet and attach it to this Application. Signature of Parent Please Print Name G. Financial Information (self-supporting, adult students): Information is CONFIDENTIAL. 1. Type of employment 2. Will you continue this or any other employment while attending college? (yes) (no) If yes, please explain 3

4 3. My/our Income Tax paid in My/our estimated Income Tax for Personal cash and savings. Stocks, bonds, real estate other than homestead, IRAs, TSAs, 401Ks, etc.. Equity in homestead. 4. Number of vehicles Car payments/semester Car insurance/semester H. Potential Resources versus College Expenses (Based on 2 semesters): 1. Resources a. Personal Income $ b. Personal Savings c. Assistance from family d. Florida Pre-paid Tuition e. Social Security Benefits f. Veteran s Benefits g. Gifts/Trust Funds, etc. h. Scholarships/Grants/Loans (1). Bright Futures (FL Merit) (2) College/University Scholarship (3) Other (4) Pell Grant (5) Stafford Loan (or other) Total... $ 2. Expenses: (AMS Trust cannot pay vehicle expenses.) a. Registration/Tuition/Other Fees $ b. Room and Board c. Books, Supplies d. Other Expenses (please list) Total... $ I attest to the fact that I have researched this information. Signature of Applicant I. To Be Considered: Submit These Required Documents to the IRSC Foundation by Monday, March 7, Completed application with photo. 2. Personal recommendation from the Pastor of your church. 3. One additional letter of recommendation. 4. A copy of last year s (2015) 1040 Form or W-2 Wage Statement. 4

5 5. Statement of educational goals, career objectives, and need, type-written (not to exceed 300 words). 6. Statement of residency (Declaration of Domicile) in St. Lucie or Okeechobee counties obtained from the Clerk of the Circuit Court at your local courthouse. 7. Up-to-date, official (sealed by Registrar) transcript from your high school and/or college or university. Students who have earned 30 college credits need not furnish a high school transcript. IRSC Foundation, Inc Virginia Avenue, Fort Pierce, FL (772) lthomas@irsc.edu 5

1.2 The amount granted for each one-year scholarship will be determined by the State Committee but will not exceed $2,500.

1.2 The amount granted for each one-year scholarship will be determined by the State Committee but will not exceed $2,500. 1.0 FLORIDA P.E.O. SCHOLARSHIP -- GUIDELINES FOR APPLICANT 1.1 CONGRATULATIONS! You have made a first step toward your college education by applying for a FLORIDA P.E.O. SCHOLARSHIP. This scholarship is