ALL INFORAMTION IS CONFIDIONTIAL Attach Recent

Mark Womack

Memorial Scholarship

Application

ALL INFORAMTION IS CONFIDIONTIAL Attach Recent

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Mark Womack Memorial Scholarship

SlidellHigh School

#1 Tiger Drive

Slidell, Louisiana70458

Name: ______

Home Address: ______

Date of Birth: ______Sex: ______Year of Graduation: ______

Sports you participated in: ______

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Your Seven Semester Grade Point Average: ______

Is your father living? Yes____ No____ Is your mother living? Yes ____ No_____

Name of Father: ______

Name of Mother: ______

Home Telephone Number: ______Other Telephone Number: ______

Email Address______

When and where do you plan to enter college? ______

What are your present career plans? ______

What field/major are you interested in? ______

ACT Scores: English ______Math ______Reading ______

Science______Writing ______Composite _____

List all awards or honors you have received, all extracurricular, community, church activities you have participated in (Sports, clubs, organizations, etc.), work experience or other service to Slidell High School. Please include any sports internships, awards or services.

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On a separate sheet of paper write an essay on why you feel you are deserving of this award.

Describe yourself and what you feel are your best personal qualities. How are you using your athletic skills in your personal, home, or school life? How have you used these skills to help others and benefit those around you?

Share with us your ideas for the future. (Where do you see yourself in 5 years?)

ESSAY MUST BE TYPED AND DOUBLE SPACED.

Financial Information

Probable Income for Academic Year:

Savings to be used (from summer earnings, etc.) ...... ______

Prospective earning from part-time work during academic year...... ______

Financial Aid to be received from parents during the academic year ...... ______

Financial Aid from other relatives or friends during the academic year ...... ______

Scholarships and grants applicable to academic year ...... ______

Other sources of income during academic year ...... ______

PARENTS’ RESOURCES:

Name of Father: ______

His Occupation: ______

His employer: ______

His annual income: ______

Name of Mother: ______

Her occupation: ______

Her employer: ______

Her annual income: ______

Including yourself, how many children are dependent upon the family income for support? ______

Including yourself, how many children will be attending college during the coming school year? ____

To certify that the information given is correct to best of your knowledge, please sign below:

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Signature of ApplicantDate

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Signature of ParentDate

Mark Womack

Memorial Scholarship

Application

Teacher, Coach, Administration Staff Request for Recommendation

Any information given in completing this check list will be held in strict confidence. We would greatly appreciate your cooperation in this request.

Applicant’s Name: ______

Teacher or Coach Name:______

Date of graduation: ______

Grade point average: ______

Comments:______

Signature: ______Title: ______Date: ______