Page 1 – Women’s Hall of Fame Scholarship Application / LANZA
2010
lANZA fAMILY FOUNDATION scHOLARSHIP APPLICATION
INSTRUCTIONS FOR SUBMITTING APPLICATION
Handwritten or incomplete applications will not be considered.
Application may be completed online but must be mailed with attachments:
ELIGIBILITY REQUIREMENTS
- Must be an African American female
- Must be a senior attending Mount Vernon or TuckahoeHigh School
- Must have WestchesterCounty as applicant’s permanent address
- Must be a U.S. citizen or a permanent resident (Copy of Alien Registration Card required)
- Application must be submitted byThursday, December 17, 2009
APPLICATION REQUIREMENTS:
- Applicant’s personal information page including essayandlist of school and
community activities
- Financial forms: (2008) 1040 income tax return & W-2 of each parent or guardian
providing financial support. If applicant is emancipated, include only your tax information
(Alltax informationwill be shredded after the event)
- Copy of Alien Registration Card, if applicable
- Official school transcript along with applicant’s GPA and class ranking
- Nominator’s response to questions
Process for Selecting Scholarship Recipients
Submissions are reviewed and chosen by the Lanza Family Foundation.
Recipients and Nominators will be contacted by telephone in late February.
APPLICATION CHECKLIST:Be sure to include the following items
APPLICANT’SPERSONAL information page
APPLICANT’Spersonal essay INCLUDINGlist of school community activities
CopIES of (2008) 1040 income tax return w-2 form
Copy of Alien Registration Card, if applicable
Nominator’s response to questions
THREE SIGNATURES – APPLICANT, PARENT OR GUARDIAN AND NOMINATOR
(see Bottom of Applicant’s personal Information sheet)
Applicant’s PERSONAL INFORMATION
Name
Address
City, State Zip
Home Phone
/Other Phone
Legal Status U.S. Citizen Permanent Resident(Copy of Alien Registration Card required)
Father’s Name / OccupationMother’s Name / Occupation
Guardian’s Name / Occupation
Parent Marital Status: Married Divorced/Separated/Single. Applicant resides with
Total Number of Siblings / Siblings attending College
SCHOLARSHIP CRITERIA - Please check one
A high school student of African American descent from Mount VernonHigh School of promise
who will be enrolled in an accredited educational program after graduation:
Demonstrates academic achievement, financial need, and commitment to her community
Lanza Family Foundation Awards - Tuckahoe: $5,000 each
A high school student of African American descent from TuckahoeHigh School of promise
who will be enrolled in an accredited educational program after graduation:
Demonstrates academic achievement, financial need, and commitment to her community
If awarded a scholarship, I will be present at the Women’s Hall of Fame & Scholarship Awards Luncheon to be held on Friday, March 26, 2010 to receive my award.
I hereby certify that all sources of financial information have been indicated in the application, I have read this application, and that it is accurate and complete to the best of my knowledge.
______
Applicant’s signatureDate
______
Parent or Guardian’s signatureDate
______
Nominator’s signature Date
APPLICANT’S PERSONAL ESSAY (must be typed –limited to box below)
Please write an essay describing your academic goals and your personal goals. What inspires you? What interests you? Describe how you have been involved in your community and school. What sets you apart from others? Please describe any extraordinary circumstances or challenges you have faced - such as family, medical and financial concerns - and how you have handled them. Please do not submit essays written for other scholarships.
Thoughtful, concise answers to these questions are most valued.
In addition, attach a list of your school and community activities (clubs, sports, volunteer work, etc.)
Please Note:Information about scholarship recipient will be excerpted from applicant’s personal essay to be included in a short biography in theprogram journal.
Click here to start typingNominator’s Information
Applicant’s nameNominator’s Name/Title
Educational Facility
(If not affiliated with an educational institution, you must supply a letter from the applicant’s school validating her enrollment)
Address
City, State Zip
E-mail / Phone
Contact Person Regarding Scholarship
(If different from nominator)
Title / PhoneQUESTIONS FOR NOMINATOR
Judges value answers with specific data and examples of applicant’s achievements. Answers must be typedin the space provided.
(NO OTHER ATTACHMENTS -EXCEPT FOR QUESTION #5)
1) What kind of education or training is the applicant pursuing?
2) What are the future goals of the applicant?
3) How has the applicant shown a commitment to her community?
4) Why do you feel the applicant is deserving of this scholarship?
5) SPECIAL CIRCUMSTANCES: please explain (include documentation if necessary)
NOTE:
Please remember to signPage 2 (Applicant’s Personal Information)
Deadline: Application due by Thursday, December 17, 2009 to:
WestchesterCounty Office for Women
112 East Post Road, Room 110B