Harold Hutchins Scholarship 2012 - 2013

HAROLD HUTCHINS SCHOLARSHIP 2012 - 2013

Application Deadline: March 30, 2012(Applications received after this date will be considered after

on-time applications.)

General Eligibility: To provide scholarships to students or graduates of Mt Vernon Township High

School, Mt Vernon, Illinois for the purposes of pursuing education at high school,

college, trade school or vocational school, at the graduate and undergraduate level.

Students must carry 12 semester hours or equivalent.

Notification: Notification will be made in writing by the U. S. Bank, N.A. Trust Department once

all scholarships are awarded.

Name ______SSN______

Address ______

Email ______Telephone No. ______

Date of Birth ______Male: ____ Female: ____ Married____ Single____

Occupation ______Employer ______

Annual Salary ______Estimated Educational costs for full academic year ______

Release Statement – Signature Required
I approve the release by the Harold Hutchins Trust of my name, address, major, class and high school if I am selected to receive a scholarship. I certify that, to the best of my knowledge all statements submitted are my own. I understand that this application and all records gathered for my application file are confidential and will not be disclosed to me. Access will be restricted to appropriate committee members.
Signature ______Date ______

Section A: (must be completed by all students applying for scholarship, except those students who are married or not claimed as a dependent on parent’s tax return, i.e. student does not live with nor receive any means of support from either parent.) (INCLUDE INCOME FROM ALL SOURCES)

Father______Occupation ______Annual Income______

Mother______Occupation ______Annual Income______

Brother(s) and/or Sister(s) (names & ages)

______

Are any siblings attending college: Yes____ No____ If so, how many ______

Section B: Education Profile

High School: ______Date Graduated: ______

Grade Point Average: ______(4-point scale)

Name and location of institution to which student has applied or is/will be attending:

______

______

______

College Academic Year: FR___ SO____ JR____ SR____

Major Area of Study: ______Degree or Degrees Pursued: ______

Expected Date of Graduation from college: ______

Other Sources of Financial Aid-List all Grants, Scholarships or Loans:

______

Section C: Educational Costs (Full Academic Year)

Tuition and Fees: ______

Books: ______

Room and Board (Campus Only) ______

Other ______

Section D: Activities

Community Service and/or extra curricular activities, hobbies, & interest:

______

______

______

______

Section E: Future Goals/Plans

Give a brief statement explaining your future goals/plans.

______

______

______

______

Section F: Any information about special needs or circumstances to help the committee in the selection process should be included

______

______

______

______

Application Deadline – March 30, 2012

(Applications received after this date will be considered after on-time applications.)

Return Application & Transcripts to:

U. S. Bank, N.A.

C/O Pam Prather

201 N Elm Street

Centralia,IL62801

ALL APPLICATIONS MUST BE ACCOMPANIED BY THE MOST CURRENTTRANSCRIPT OF ACADEMIC RECORDS. IF YOU ARE ALREADY ATTENDING COLLEGE, and RE-APPLYING, ONLY YOUR COLLEGE TRANSCRIPT IS NECESSARY.

If you have questions or need further information:

U. S. Bank, N.A.

Phone: 618-545-1219

Fax: 618-533-7155

Email: