CONFIDENTIAL SCHOLARSHIP APPLICATION
Date ______
CATEGORY (check all that apply):
TrussvilleSon/Daughter ofChamber
Senior______TACC Member______Ambassador______
(Trussville Area Chamber of Commerce)
Name: Mr./Miss______
Home address and
other contact info:
______
StreetCity
______
StateZip CodeTelephone #
______Email address
Date of birth:______Sex: M / F (Circle one)
Father’s name:______Occupation:______
Mother’s name:______Occupation: ______
Step-father’s name:______
Step-mother’s name ______
High schools or home schools attended: ______
______
Colleges applied to (circle those where you have been accepted):
______
Have you decided where you will attend college? ______If so, where?______
Anticipated college entrance date:______
Projected major field of study:______
Career objective: ______
______
High school or home school GPA: ______ACT score (composite):______
List all sources and amounts of college funds awarded or available to you, e.g., other
scholarships, gifts, trusts: ______
How much (in dollar amount) of your awarded scholarship money can be used
at the educational institution you have chosen?______
Work experience: ______
Community volunteer experience: ______
______
______
Approximategrossmonthlyhousehold income:$______per month
If there are other children in your immediate family who receive support from your parents, list only their ages. Do not include yourself. ______
Number of your brothers & sisters who will be in college at the same time as you
(if applicable – do not include yourself): ______
If any, when and where: ______
Please attach a copy of your resume to this application and have your school guidance counselor or guardian of record attach a copy of your transcript to this application. Please describe on an attached typedsingle page why you need a scholarship.
I, the undersigned, certify the information I have submitted to be true and correct, and I understand that my receipt of scholarship funds from other sources may result in ineligibility for a Trussville Area Chamber of Commerce (TACC) Scholarship.
APPLICANT’S SIGNATURE: ______
PARENT’S SIGNATURE: ______
DATE OF APPLICATION: ______
This application must be turned in by Friday, April 7, 2017, at 4 p.m. in a labeled envelope to:
Trussville Area Chamber of Commerce
400 Main Street
Trussville, AL 35173
(NOTE: The Chamber office is now located across from The Chocolate Biscuit and next door to King Family Chiropractic.)
Additional notes:
TACC scholarships are awarded only to high school or home school students (no college students except for renewals) who reside in the Trussville city limits.
Some scholarships are designated for renewal for up to four (4) years if the applicant maintains a “B” average or better.
An ‘official’ transcript is not necessary.
PLEASE DONOTFOLDOR STAPLEANY PART OF YOUR APPLICATION, AS IT MAKES IT DIFFICULT TO COPY.
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