Sapienza Scholarship Application Cover Sheet
Applicant Name: ______
This program provides need-based scholarship awards to New Canaan residents. By filling out this application, you can apply to one or more of the following scholarships:
· Sapienza Scholarship – the New Canaan Community Foundation’s general scholarship award.
· The Joseph F. Dorrico Rotary Award – if applicable, an additional award for community service.
· Silver Hill Scholarship – if applicable, an additional scholarship for students whose intended field of study in college and their future career is related to health care. Students may apply during their senior year of high school, after college acceptance, and may be awarded $2,000 per year during each year of post-secondary education.
All applications are presented to the committee anonymously. In order to be considered, please print, sign, and deliver the completed application and all supporting material to the office by 5:00pm on the deadline of Monday, May 8, 2017.
Please confirm the following requirements before submitting your application:
□ New Canaan resident with a demonstrated need for financial assistance
□ GPA of 2.5 or higher (Returning Applicants)
□ Attending a not-for-profit school or educational organization
□ Completed Application Form and signed Cover Sheet
□ Student Aid Report (SAR) with Expected Family Contribution (EFC) through FAFSA
□ Most recent Federal tax return Form 1040
□ Financial Aid Award letter from College Attending
□ Statement of Financial Need from Parents
□ Official Transcript Requested
□ Personal Statement (New Applicants Only)
□ One Recommendation (New Applicants Only)
______
In submitting this application I (we) certify that the information provided is complete and accurate to the best of my (our) knowledge. I (we) understand that the falsification of information may result in termination of scholarship grants. I (we) also grant permission to New Canaan Community Foundation to use my name photograph and/or selected quotes on their website and in future publications, if I (we) receive scholarship funds.
Student: ______Date ______
Signature
For applicants under 18:
Parent or Guardian ______Date ______
Signature
Sapienza Scholarship Application Form - Deadline: May 8, 2017
Applicant Information
Name ______
Last First Middle Initial
Permanent Address
Street ______City______State ___ Zip ______
Date of Birth ______Male Female
Phone Number______Cell Phone ______E-Mail ______
Family Information
Names and Ages of Siblings ______
Father/Guardian Name ______
Last First Middle
Street Address ______City______State ____ Zip ______
Phone Number______Cell Phone ______E-Mail ______
Employer______Occupation ______
Mother/Guardian Name ______
Last First Middle
Street Address ______City______State ____ Zip ______
Phone Number______Cell Phone ______E-Mail ______
Employer______Occupation ______
Are your parents married, divorced, or separated? ______
Current School Information
All applicants must submit an official high school or college transcript.
Current School or High School ______Graduation Year ______
School Address ______
Will you be on campus both semesters? Yes / No
If No, please explain:______(Internship, Study Abroad, semester off, etc.)
______
Family Financial Information
The Sapienza scholarship program was established to help students who need financial assistance to continue their education. Therefore, all requested financial information must be provided:
§ Complete the Free Application for Federal Student Aid (FAFSA) form and submit a copy of the Student Aid Report (SAR) which shows the Expected Family Contribution (EFC) to the cost of the education.
§ Submit a copy of the most recent tax return Form 1040 (both pages, without attachments)
§ Each applicant’s parents must submit a short written, signed statement of financial need, outlining the family’s overall financial situation and their request for assistance. Please describe why the applicant needs this scholarship and how it will make a difference for this student and family.
Scholarship Information
School applicant will attend: ______
Address: ______
Program Name (e.g. undergraduate degree, Masters degree in Teaching, etc.): ______
Grade entering in the Fall: ______
Financial Aid Package:
Please provide the Financial Aid Award letter provided to you by your school.
List the name and amount of any additional outside grants or scholarships or loans you are seeking or have been awarded for this upcoming year and that are not included in the letter. If the award is pending, please indicate the date you will be notified.
Scholarship / Grant: ______
Scholarship / Grant: ______
Loans: ______
Other: ______
Awards & Honors, School & Community Involvement
Please list any awards and honors you have received and describe any school-related and community activities in which you participated.
Award/Honor or Activity / Description / DateEmployment
Beginning with your present or most recent job, please list your employment history.
Employer / Position / Dates / Hours/week
The Joseph F. Dorrico Rotary Award
To be considered for this additional award, describe your community service and why you should be selected.
Silver Hill Scholarship
To be considered for this additional award, describe your intended field of study in college and career interests related to health care.
The following items are required FOR NEW APPLICANTS ONLY
§ Personal Statement
Please include an essay, which includes your plans as they relate to your educational and career objectives and future goals. Please include a description of your leadership and community service involvement. Please limit your statement to one typed page.
§ Recommendation
One completed reference form must be forwarded by the person completing the form or writing the letter directly to the Foundation. If you are currently enrolled as a student, your reference form must be completed by a current teacher or an adult with whom you have a professional relationship outside of school. Recommendations cannot be written by family members.
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