NEW JERSEY STATE SOCIETY DAUGHTERS of the AMERICAN REVOLUTION
SCHOLARSHIP
TO THE APPLICANT: Please type or print, clarity is necessary. All areas must be completed. Place N/A if something does not apply (i.e. Class rank or ACT test). Give full names and locations (no initials). Send four (4) applications {1 original and 3 copies of the application form), attaching copies of extra papers to each form. Include (4) transcripts of grades and (4) copies of one letter of recommendation (preferably but not necessarily from a Guidance Director).
DAR CHAPTER CHAIRMAN MUST RECEIVE FOUR COMPLETED APPLICATIONS
BY NO LATER THAN DECEMBER 5, 2014.
Late or incomplete arrivals are disqualified.
APPLICANT INFORMATION
APPLICANT NAME: ______Telephone: ( ) ______
Street Address: ______City: ______, NJ Zip: ______
DATE OF BIRTH: ______Are you an American Citizen? (Check one)___ Yes ___ No
COMPLETE NAME AND ADDRESS OF HIGH SCHOOL ATTENDING:
High School Name: ______
Street Address: ______City: ______, NJ Zip: ______
CLASS RANK: ______CLASS SIZE ______
SAT SCORES: MATH______CR_____ WRITING______ACT SCORES:______
IN ORDER OF PREFERENCE, LIST COLLEGES TO WHICH YOU HAVE APPLIED: ______
______
FINANCIAL NEED REPORT
NAME OF FATHER OR LEGAL GUARDIAN (Circle One):______
Street Address: ______City: ______, NJ Zip: ______
Employer:______
Position:______
Employer’s Address: ______
NAME OF MOTHER OR LEGAL GUARDIAN (Circle One):______
Street Address: ______City: ______, NJ Zip: ______
Employer:______
Position:______
Employer’s Address: ______
Page 2: New Jersey State Society DAR Scholarship Application Form
Number of dependents in family, other than applicant or parents – list names and ages:
______
TOTAL 2013 INCOME - Father/Guardian: ______
Mother/Guardian:______
PER IRS FILING FOR Applicant: ______
Other Income if applicable: ______
Scholarships/Grants Received:______
Signature of Father/Legal Guardian: ______
Signature of Mother/Legal Guardian:______
Signature of Applicant: ______
For Reference, please give name, address and telephone number of:
CLERGYMAN: ______
SCHOOL AUTHORITY:______
OTHER: (preferably an employer):______
Please list the following activities, estimating hours per week given to each: Additional pages may be attached:
HOME RESPONSIBILITIES: ______
______
COMMUNITY SERVICES: ______
______
CHURCH: ______
______
WORK/ACITIVITIES (after school, week-ends, summer): ______
_
AWARDS (include specialized studies; hobbies such as music, art, photography, sports, dance, etc.) ______
______Page 3: New Jersey State Society DAR Scholarship Application Form
What is your CAREER GOAL as you presently see it? Write just a short, simple paragraph or two, using the sheet below:
RETURN FOUR (4) COMPLETED APPLICATION FORMS TO THE PERSON LISTED BELOW:
SPONSORING DAR CHAPTER: Captain Joshua Huddy Chapter
RETURN NO LATER THAN FRIDAY, DECEMBER 5, 2014.
TO: Caroline K. Germond, Ed.D.
5 Andover Ct.
Whiting, NJ 08659
TELEPHONE NUMBER: 732.350.9226