Groton Scholarship Fund, Inc.

C/O FitchSenior High School

101 Groton Long Point Rd.

Groton, CT 06340

SCHOLARSHIP APPLICATION - 2014

It is IMPORTANT to COMPLETE ALL PARTS of this application.

THIS MUST BE RETURNED TO THE GUIDANCE OFFICE BY MARCH 8TH, 2014

Applications received after the deadline will not be considered.

Scholarships are awarded based on any of the following:

1. Academic achievement

2. Special areas of interest, such as math, engineering, music, education, military service,

history, etc.

3. Financial need

4. Contribution to school and community including work experience.

Complete this application in its entirety so proper consideration for all awards may be made.

Type your name in the header section or write on each page. If more space is needed,

tab to the next column in the table or write on additional pages.

PLEASE TYPE OR PRINT

NAME IN FULL
HOME ADDRESS
SUMMER ADDRESS / (if different)
PHONE
SUMMER PHONE / (if different)
Anticipated major field of study?
Which institutions have you applied? / Have you been accepted? Y N Not Yet
1.
2.
3.
4.

Student’s Name (Print): ______

FAMILY/FINANCIAL INFORMATION

* This information is required to determine financial need.

Name of Father/Stepfather/Guardian
Name of Mother/Stepmother/Guardian
Name of Father/Stepfather/Guardian Employer & Occupation
Name of Mother/Stepmother/Guardian Employer & Occupation
Annual Family Income / check
$0-$25,000
$25,001-$50,000
$50,001-$75,000
$75,001-$100,000
$100,001-$175,000
$175,001+
Financial Scholarships applied/awarded toward your college education.
Name of scholarship applied for / $ amount / Awarded
Yes / No / Not Yet
# of Dependents other than you in your family Age of each dependent
In a few words, explain any unusual financial conditions carried by your family, which may
indicate a need for financial assistance. (i.e. divorce, death, illness, job loss, etc.)

Student’s Name (Print): ______

SCHOOL AND COMMUNITY ACTIVITIES

1(A)List your school activities (including sports, clubs, yearbook, etc.)

Put a check against each year in high school you participated.

School Activity / Leadership
Position / YR
9 / YR
10 / YR
11 / YR
12

1(B)List any awards received (including academic, sports and other activities).

2.What activities do you have while not in school? Include community, volunteer activities, employment, etc. that you have been involved in. Be as specific as possible. Example: Volunteered for Special Olympics, YR 9; 60 Hrs. Please list approximate hours PER YEAR for each activity. It is important you list your hours by year AND total these hours in the Total Hours column. In the Total of ALL Activities field, enter the sum of the Total Hours column.

Community/Volunteer Activities/Employment / YR
9 / #
Hrs / YR
10 / #
Hrs / YR
11 / #
Hrs / YR
12 / #
Hrs / Total
Hours
TOTAL of ALL HOURS

Student’s Name (Print): ______

ADDITIONAL INFORMATION

1. Are you a dependent of a member of the United States Armed Forces (active, retired, or deceased)?

Yes
No

2. Please put an X next to all Groton Schools you attended:

Charles Barnum Elementary / Noank Elementary
Claude Chester Elementary / Pleasant Valley Elementary
Colonel Ledyard Elementary / S.B. Butler Elementary
Eastern Point Elementary / Cutler Middle
Groton Heights Elementary / Fitch Middle
Mary Morrison Elementary / West Side Middle

3.Are you or someone in your family a member of the International Association of Firefighters?

Yes
No

If yes, please answer the following:

Name of Member
Relationship to you

4. Is someone in your family a member of a fire department?

Yes
No

If yes, please answer the following:

Name of Member
Relationship to you

5. How many IB courses have you taken?

6. How many Advanced Placement courses?

Yes

7. Do you anticipate receiving an IB Diploma?

No

Student’s Name (Print): ______

ESSAY

In Your Words –attach a typed essay (double spaced / 1 page)

Kindly explain why you feel deserving of a scholarship from the Groton Scholarship Fund.

Application should include download of SAT/ACT scores and verification of your Estimated Family Contribution(EFC) listed on the Student Aid Report (SAR).

STUDENT and PARENT/GUARDIAN CONSENT SECTION

I certify that this application represents, to the best of my knowledge, the facts, as I know them. We give our permission to Fitch High School to include a copy of my transcript with this application to be reviewed by the Groton Scholarship Committee.

Student’s Signature: / Date:
Parent/Guardian Signature: / Date:

Important note: All information submitted to the Groton Scholarship Fund is used for scholarship award determination. No information is shared with a third party and is properly destroyed.

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