2017 SCHOLARSHIP APPLICATION

Scholarships to be awarded up to $1,000

Purpose:

To provide financial assistance to theAdult Learner returning to school.

APPLICATION

This application is a guideline for the Scholarship Committee’s decision. All questions MUST be answered and all documents requested MUST be included with the application in order for it to be considered.

ELIGIBILITY REQUIREMENTS

In order to be considered for a Zonta Club scholarship, the applicant MUSTINCLUDE IN THEIR PACKET WITH THEIR APPLICATION PROOF THAT THEY:

  1. ______Are current resident of Warren County.
  2. ______Are a high school graduate or have obtained a GED.
  3. ______Are enrolled in, or are seeking acceptance to, a certificate or degree program

at the time of this application.

  1. ______Provide a copy of their last Federal Tax Return.

By checking the above 4 items listed you have indicated that these itmes are included with your application.

DEADLINE: RECEIVED (via postmark or electronically) by April 29, 2017

ZONTA SCHOLARSHIP COMMITTEE

P.O. BOX 335

WARREN, PA 16365

Questions may be directed to committee chair:

Jetta Bishop

Home phone:814-563-4506

2017 ZONTA SCHOLARSHIP APPLICATION

  1. Name: ______
  2. Mailing Address: ______
  3. Phone: Home ______Work ______Cell ______
  4. E-mail address: ______
  5. Status: ___Single ___Married ___Divorced ___Separated ___Widowed
  6. Are you claimed as a dependent on anyone’s tax return? ___Yes ___No
  7. Do you claim anyone on your tax return? ___Yes, how many?____; ___No
  8. Please list any work or academic achievements and/or honors you would like the committee to be aware of: ______
  9. Please list any committee service or volunteer work you have performed: ______

EDUCATION INFORMATION

  1. High School Attended: ______
  2. Year of Graduation or GED: ______
  3. Have you attended any post-secondary programs in the past? ___Yes ___No
  4. If yes, please list ALL courses and grades, OR attach transcripts.

School Attended: ______

EDUCATION INFORMATION, continued

Course Title / Grade Earned / Date

Please use the back of any page of the application for any information.

  1. Certificate or degree are you working toward: ______
  2. Specify your area or course of study: ______
  3. Attending ___Full Time ___Part Time
  4. Name of school or college: ______
  5. Number of courses taken each term: ______
  6. Expected completion date: ______

WORK EXPERIENCE

List your work experience with the MOST RECENT first:

EMPLOYER / JOB TITLE / # YEARS / PHONE #

FINANCIAL AID INFORMATION

  1. Estimated cost per semester, term, course or certificate: ______
  2. How many classes will you take this year (2017)? ______
  3. Have you applied for any other scholarships, grants, employer reimbursement, or any other financial aid? ___Yes ___No
  4. If yes, or if you plan to, please indicate the source of financial aid and amounts expected: PHEAA $______Student Loans $______Employer Reimbursement $______Other $______Total Amount $______

EXPECTED FUTURE PLANS

On only ONE (1) additional page, please write or type your expected educational, personal, and professional goals. Include expected occupation, location of employment, and academic goals.

VERIFICATION

I, the undersigned, if asked, will provide proof of the information contained in this application. This may include, but is not limited to, state or federal income tax returns, school transcripts and school/program acceptance letter. I agree those persons/employers listed under employment may be contacted as a reference. To the best of my knowledge the information contained in this application is complete and accurate.

If I am awarded a scholarship, I agree to notify the Zonta Club of Warren Scholarship Committee at the address below if I fail to satisfactorily complete the credits or courses covered by the scholarship, AND I agree to repay the Zonta Club of Warren upon withdrawal from the educational program.

Signature: ______Date: ______

Send Completed application via mail and the required 4 documents listed on page one:

Zonta Club of Warren Scholarship Committee, P.O. Box 335, Warren, PA 16365

**If you are called for an interview, please check ALL times that would be convenient:

___Afternoon ___Evening ___Saturday ___Other______

If you need a request form for the information required for this application, please use the following:

AUTHORITY TO RELEASE INFORMATION

The Zonta Club of Warren, P.O. Box 335, Warren, PA 16365 and this student request the following information for determining scholarship eligibility and aid in the selection process: ______

Your signature: ______Date: ______

Printed name: ______

Address: ______

______