2 West Main Street, Suite 101

Uniontown, PA 15401

724-437-8600

2017 College Scholarship Application

Instructions:

Please print clearly and use ONE paper clip on the entire application. DO NOT STAPLE.

All required documents must be attached. Incomplete applications will not be accepted.

Applications must be post-marked by March 24, 2017 and mailed to CFFC.

NAME OF SCHOLARSHIP: Debra A. Mascia Memorial Scholarship

Candidate must be a Brownsville Area High School senior, Fayette County resident, holding a 3.2 GPA or higher.
Preference will be given to a student who plans to major in any of the following: vocal performance, music education or musical theatre, or (in the event that there is no applying students majoring in these areas) a foreign language major.

STUDENT INFORMATION

NAME: ______

(Prefix)(First)(MI)(Last)

ADDRESS: ______

(Street Address – No P.O. Box)(City) (ST) (ZIP)

HOME PHONE: ______ALTERNATE OR CELL PHONE: ______

E-MAIL ADDRESS: ______BIRTHDATE: ____/_____/_____

EDUCATION (Current Official Transcript must be attached)

What is your Cumulative GPA? _____

I am currently attending the following high school: Brownsville Area High School

Estimated Graduation Date: ______

SAT Score: TOTAL Math/Reading/Writing: ______ACT Score: ______

This Fall, I plan to attend the following post-secondary school: ______

School Address: ______

(Street) (City) (ST) (ZIP)

What will be your Major/Field of Study? ______

ACTIVITIES

Within the last four years, I’ve been a member of the following Club(s)/Committee(s): ____________

______

Special Awards, Honors or Other Information: ____________

______

Within the last four years, I’ve participated in the following sports: ______

______

WORK EXPERIENCE

Name of Employer: ______Type of Work: ______

Start – End Dates: ______Approximately how many hours do you work each month? ______

Name of Employer: ______Type of Work: ______

Start – End Dates: ______Approximately how many hours do you work each month? ______

VOLUNTEER EXPERIENCE

Organization: ______Type of Work: ______

Start – End Dates: ______Approximately How Many Hours do you volunteer each month? _____

Organization: ______Type of Work: ______

Start – End Dates: ______Approximately How Many Hours do you volunteer each month? _____

SPECIAL CIRCUMSTANCES:

If you and/or your family have been dealing with extenuating circumstances that are creating a financial burden, briefly explain those circumstances: ______

______

REQUIRED DOCUMENTS

IF THESE DOCUMENTS ARE NOT ATTACHED,

YOUR APPLICATION WILL NOT BE ACCEPTED

A copy of your most recent OFFICIAL transcript.
One letter of reference (parents and immediate family members are NOT eligible as a reference.)
A 300-500 word essay on the following: What is something you’ve changed your mind about in the last three years? What motivated you to make that decision?

CONSENT & VERIFICATION

In submitting this application, I certify that the information provided in this application is complete and accurate to the best of my knowledge. I understand that all decisions made by the CFFC Scholarship Committee(s) are final and not subject to review or appeal. I further understand that any information provided in this form may be shared with committee members and donors of the sponsoring scholarships. Also, I understand that falsification of information may result in termination of any scholarship granted. If selected to receive a scholarship, I agree to the use of my name, likeness, and information contained in my application (excluding any financial information) for promotional purposes for the Community Foundation of Fayette County, without further compensation or notification.

Student’s Signature: ______Date: ______

Printed Name: ______

Parent’s Signature: ______Date: ______

(If student is under 18 years of age)

Printed Name: ______

If you are selected to receive an award, you will be notified in May.