Evansville Vanderburgh School Corporation Application for Scholarships

Return completed application to school counselor by deadline.

1. Name: / Last / First / Middle / Birth Date: / DOB /
2. School: / High School Attending / Social Security Number: / XXX / XX / XXXX /
3. Permanent Address: / No. & Street / City / State / Zip /
4. Parent/Guardian Name(s): / First Last / First Last /
5. Parent/Guardian Address: / No & Street / City / State / Zip /
6. Student Phone: / Area Code / Phone / Parent/Guardian Phone: / Area Code / Phone /
7. Are parents separated? / ☐Yes / ☐No / Divorced? / ☐Yes / ☐No
8. Is father living? / ☐Yes / ☐No / Occupation of father or male guardian: / Occupation /
Company: / Company / Position/Title: / Position/Title /
9. Is mother living? / ☐Yes / ☐No / Occupation of mother or female guardian: / Occupation /
Company: / Company / Position/Title: / Position/Title /
10. Please explain, briefly, any special family circumstances the committee should be aware of (divorce, family illness, special housing problems, loss of employment etc.):
Please write a brief description
11. Name of college/university you plan to attend: / Name of college/university /
Address: / No. & Street / City / State / Zip /
12. Major course of study and/or career goal: / Major/Career Goal /

13. All information is confidential and read by Scholarship Committee only. Please attach small photo to this application.

Community / Church Activities / Community / Church Honors or Awards / # of Years
Activity / Honors/Awards / Years /
Activity / Activity / Activity /
Activity / Activity / Activity /
Activity / Activity / Activity /
Activity / Activity / Activity /
Activity / Activity / Activity /
Activity / Activity / Activity /

14. List school extracurricular activities, offices held, honors/awards received. (Attach supplementary sheet if necessary)

Activity / Offices Held / Honors/Awards / # of Years
Activity / Office / Honors/Awards / Years /
Activity / Activity / Activity / Activity /
Activity / Activity / Activity / Activity /
Activity / Activity / Activity / Activity /
Activity / Activity / Activity / Activity /

15. List your employment experiences, part or full time, or at least eight (8) weeks duration. Begin with the most recent.

Type of Employment / Place of Employment / Dates of Employment
Position / Position / Start / Stop /
Position / Position / Start / Start /
Position / Position / Start / Start /
Position / Position / Start / Start /
16. Write a brief statement about your educational / career goals. Give your reasons for desiring a scholarship and any unusual circumstances that may be of help to the committee.
Please Enter Your Statement Here

The information on this form is true to the best of my knowledge.

______

Parent/Guardian SignatureDate

______

Student SignatureDate

Attachments:

  • Please attach a copy of the letter of acceptance to college/university.
  • Please attach a copy of the Student Aid Report (FAFSA). If no form is attached, the committee will assume a financial aid form was not filed.
  • Return completed application to your school counselor and request that a transcript of your academic record be attached to this application.