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Local Scholarship Directions------
You may turn in local scholarship applications starting January 2. The last day to turn in local scholarship applications will Monday, February 25 by 8:00am. Late scholarships will not be accepted. If you have a tendancy to be late or absent from school, please make sure all applications are turned in before Monday. Do Not take a chance!!
Remember to attach a copy of your transcript, resume, and copy of 2012 1040 Tax return(s). For example, if you decide to apply for 20 local scholarships, print this form 20 times. Then, write the name of each particular scholarship at the top of the form. You must give your completed forms to either Mrs. Phelps or Mrs. Chapman. You must give them to one of us yourself, and you must sign off that you gave them to us.
You will hand in the three page local scholarship form, a transcript, a RESUME, and a copy of 2012 IRS 1040’s for each scholarship.
**You do not have to disclose your financial information, but some scholarship committees do look at financial information.
Remember there are lots of other scholarships to apply for your senior year. Make sure you are checking the website daily weekly.
Please check with Mrs. Phelps if you have any questions. Mrs. Phelps’s office number is 274-4585. Mrs. Phelps will be glad to meet with parents about post-secondary plans.
Please keep track of scholarships for which you have applied. Most of the donors will notify the guidance office of winners ONLY. They DO NOT contact you if you are NOT the recipient.
2013 LOCAL SCHOLARSHIP FORM
Name of Scholarship for which you are applying:
Phone Number Where You Can Be Reached:
PLEASE NOTE: ALL INFORMATION ON THIS FORM IS CONFIDENTIAL. THE PERSONS
SERVING ON SCHOLARSHIP COMMITTEES WILL RESPECT YOUR RIGHT TO PRIVACY. THIS FORM IS FOR LOCAL SCHOLARSHIPS ONLY. YOU MUST COMPLETE OTHER SCHOLARSHIP FORMS FOR COLLEGE OR VOCATIONAL SCHOOL.
Name:
Address
Date of Birth: SS#: Sex: oMale o Female
Marital Status: oSingle o Married Dependents: o Yes o No
Telephone (Day) (Night)
Your Class Schedule
1st Period-
2nd Period-
3rd Period-
4th Period-
5th Period-
6th Period-
7th Period-
Elementary School from which you attended:
Parents or Guardians Names:
Mother’s Name Occupation
Father’s Name Occupation
Stepfather’s Name Occupation
Stepmother’s Name Occupation
Parents Status Father (Living) Yes No Mother (Living) Yes No
With Whom Do You Live? Father/Mother Stepfather/Mother Father/Stepmother
Father Only Mother Only Stepfather Only
Stepmother Only Grandparents (Both)
One Grandparent Other relatives
Occupations of those with whom you live if you don’t live with parents
Relative: Occupation:
Relative: Occupation:
High School from which parents graduated:
Is either parent or grandparent a military veteran or on active duty? oYes oNo
IF YES, please list the branch or branches of service:
GPA at end of Junior Year______
GPA weighted scale end of Junior Year______
(You must check with the guidance office if you are unsure. Absolutely must be accurate)
Total Absences 9th through 11th grades______Rank End of Jr. Year______
ACT Composite _____SAT Math____SAT Verbal____ (Best scores)
College or Vocational School Planning to Attend in order of preference/ choice 1.______3.______
2.______4.______
Intended Field of Study______
How many persons in college or vocational school at this time? Parent(s)______Brothers___
Sisters______
Will there be others in your family attending school (college or vocational) during 2013-2014 school
year? DO NOT INCLUDE YOURSELF. Please list their names:______
______
Write a brief essay about future occupational plans.:
Write a brief essay on why you deserve this scholarship. (Do not discuss financial need)
Do you have any special circumstances or information of special interest, which you feel, is necessary for the scholarship committee to know (unusually high medical bills, long term unemployment, disabilities, etc.)
Answer the following questions about yourself (the student). If you filed a 2012 tax return, please attach the first two pages of the 1040.
1. For 2012, did you (the student) file an IRS tax return? Yes No
2. How much do you (and spouse) receive in social security benefits for 2012?______
Answer the following questions about the student’s parents. You will need to attach the first two pages of your parent’s 2012 IRS 1040.
3. What is your parents’ marital status as of today?______
a. Married/remarried b. Single
c. Divorced/Seperated d. Widowed
4. Month and year they were married, separated, divorced or widowed?______
Father’s Name?______
Step-Father’s Name?______
Mother’s Name?______
Step-Mother’s Name?______
5. How many people live in your household?______
List names: ______
6. In 2012, did you, your parents or anyone in your parents’ household receive benefits from any of the federal benefit programs listed. Check all the programs that apply.
oSupplemental Security Income oFood Stamps oFree or Reduced Price Lunch oTANF oWIC
7. What income tax return did your parent file for 2012?
o IRS 1040 oIRS 1040A or 1040EZ o A foreign tax return
8. What was your parents’ adjusted gross income for 2012?______
Adjusted gross income is on IRS Form 1040-line 37; 1040A- line 21; or 1040EZ-line 4
9. How much did your parents earn from working (wages, salaries, tips, combat pay, etc) in 2012?
Father/Stepfather______Mother/Stepmother______Answer this question whether or not they filed a tax return. This information may be on your W-2 forms, or on IRS Form 1040-line 7 +12+18+ 14 of IRS Schedule K-1 (Form 1065); 1040A-line 7; or 1040EZ-line1.
10. How much do your parents receive in social security benefits for 2012?______
11. What was the total amount parents received in child support in 2012?______