The Westport Woman’s Club, Inc.
44 Imperial Avenue, Westport, CT 06880
(203) 227-4240 Fax: (203) 227-0367
Scholarship Application
(type or print clearly in ink)
Student’s Name: ______PHOTO
Last First Middle
Tape or staple a
Student’s Address: ______recent 2 x 3 photo.
Be sure your name
City/State/Zip: ______is on the back of
the photo.
Phone Number: ______(Area Code)
All applications and interviews are held in the strictest confidence by the committee.
The Westport Woman’s Club awards scholarships for tuition only. Awards, which are sent directly to the college, are made on the basis of:
· Financial need – top priority
· Student’s Scholastic record (No lower than 3.0 Academic GPA)
· Student’s efforts to contribute to his/her financial needs for educational purposes
· Student’s participation and degree of involvement in school and/or community activities
· Students must be in an ongoing program
Statement by parents:
My son/daughter ______is submitting this application with my permission. Attached is a copy of my federal income tax return for the calendar year 2016. (If you wish, this may be submitted in a sealed envelope. If you choose to have the copy returned to you, please include a self-addressed stamped envelope.) Review of IRS forms will be done solely by the Scholarship Committee and will remain strictly confidential.
______
Signature of parent or guardian
1
Name ______Nickname ______
Social Security no. ______Tele. ______Birthdate _____/_____/_____
Father’s Name ______Occupation ______
Employer ______Gross compensation $ ______
Mother’s name ______Occupation ______
Employer ______Gross compensation $ ______
Other income summarized from latest federal income tax form:
Alimony, child support $ ______
Dividends, interest, capital gains, rental $ ______
Unemployment compensation $ ______
Other sources $ ______
Name of brothers and sisters Age School attending
and other dependents
______
______
______
______
______
______
Extra-curricular and community activities, special recognition, etc.
______
______
______
______
______
______
______
Jobs held, other than volunteer (with approx. time committed) ______
______
______
______
If presently working, where? ______
Average hours per week ______
2
Westport Woman’s Club Application of ______
(Student’s name)
College applications filed and brief reasons for choices
(in order of preference)
1. ______
2. ______
3. ______
4. ______
5. ______
6. ______
Costs per year 1 2 3 4 5 6
Tuition $______$______$______$______$______$______
Room & board ______
Books, misc. ______
Transportation ______
Total $______$______$______$______$______$______
Funds available
Student $ ______
Additional anticipated earnings $ ______
Parents $ ______
Loans $ ______
Other sources (specify) $ ______
Total $______
For what other scholarships have you applied? ______
______
All Applications must contain:
· Personal statement
· Official transcript (Mrs. Fugitt will provide)
· Letter from Guidance Counselor (Mrs. Fugitt will provide)
· Copy of parent or guardian’s current year 2016 federal tax return
INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED
PLEASE RETURN TO MRS. FUGITT (GUIDANCE) DEADLINE: MARCH 21, 2017
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