THE LUCILLE HARRISON CHARITABLE TRUST SCHOLARSHIP APPLICATION. Name (Last) (First) (Middle) 3. County State Zip Telephone

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1 THE LUCILLE HARRISON CHARITABLE TRUST SCHOLARSHIP APPLICATION 1. Name (Last) (First) (Middle) 2. Street City 3. County State Zip Telephone 4. Are you a permanent resident of Harrison County? 5. M F SSN Sex Date of Birth 6. address 7. Father s or Guardian s Name Address Phone No. Father s or Guardian s Occupation Employer Phone No. Employer s Address Mother s or Guardian s Name Address Phone No. Mother s or Guardian s Occupation Employer Phone No. Employer s Address 8. List other dependant family members in the same household, their relationship to you, their ages and indicate if they are employed full-time or are college students. 1

2 9. State funded, accredited college or university for which the scholarship is requested and the anticipated subject area. School City Subject Area Accredited Yes ( ) No ( ) Accepted ( ) Acceptance pending ( ) Enrolled ( ) Will live on campus ( ) Will Commute ( ) 10. Are you pursuing a 4-year degree? Yes No 11. Schools attended (Ninth grade through present) Name of School Dates Attended Name of School Dates Attended Name of School Dates Attended QUESTION 12 FOR HIGH SCHOOL SENIORS ONLY 12. High School Graduation Date Number in Class Rank in Class High School G.P.A. ACT Scores SAT Scores National Merit Qualifying Scores Present Year in School Cumulative G.P.A. 13. List membership and participation in school organizations and activities. Specify any positions of leadership. Please do not abbreviate organization and/or club name(s). 14. List membership and participation in community, civic, and religious organizations and activities. Specify any position of leadership. Please do not abbreviate. 2

3 15. List any honors awarded. 16. List work experience. Employer Phone No. From To Position Employer Phone No. From To Position Employer Phone No. From To Position 17. List other scholarships, grants, and loans you are seeking or which have been awarded. Granted ( ) Pending ( ) Source Amount Sought/Received Granted ( ) Pending ( ) Source Amount Sought/Received 18. Where do you expect to obtain funds for school? Scholarship Parents Part-time Work Loans Other 19. Circle family income range: Under $10,000 $10,000 - $14,000 $15,000 - $24,999 $25,000 - $34,999 $35,000 - $44,999 $45,000 & Over 20. Please state any unusual family or personal circumstances you feel warrant the attention of the selection committee. I certify that the information contained in this application is complete and accurate to the best of my knowledge. Applicant s signature 3 Date

4 Along with this application you must submit the following: * Transcripts from all high schools * A completed copy of your Federal Aid Form * A copy of your parents last Federal Income Tax return * Three letters of recommendation * Letter of acceptance from college/university Applications will not be considered if the required items are not submitted. Return this completed application, along with the required items listed above to your high school counselor. DEADLINE FOR SUBMITTING A COMPLETED APPLICATION IS APRIL 28th, WHICH MEANS THE APPLICATION MUST BE RECEIVED BY HUNTINGTON NATIONAL BANK BY THE DEADLINE DATE. Huntington National Bank will notify the recipient(s) of the scholarship in writing prior to June 1 st. 4

5 (TO BE COMPLETED BY THE HIGH SCHOOL COUNSELOR.) TO THE APPRAISER: You have been asked to provide information in support of the below named student s application for financial aid. In fairness to the students and to those who must process this application, please give your immediate attention to this appraisal and return the completed application, together with a CURRENT TRANSCRIPT OF GRADES to: The Lucille Harrison Charitable Trust Scholarship The Huntington National Bank Trust Department P.O. Box 633 WE3013 Charleston, WV Thank you for your assistance and prompt attention to this matter. The application deadline is May 1 st. of who Applicant s Name Address plans to attend has applied for student School financial aid and has given your name as a reference. By completing this form you will make it possible for the applicant to be considered for a scholarship from the Lucille Harrison Charitable Trust. A. Period of time you have known applicant B. How well have you known the applicant? Very well ( ) Fairly well ( ) Limited contact ( ) C. Please rate the student from one (1) to four (4) on the following items (four being the highest rating and one being the lowest). Please circle the appropriate number for each item. 1. Based on the student s ability and capabilities, the student has made a wise and realistic choice for a post-secondary educational program. 2. The student exhibits a strong commitment to studies The course of studies has prepared this student for future educational plans. 5

6 4. This student has contributed to the school activities Achievement records reflect this student s ability This student is emotionally able to cope with future academic requirement. 7. This student s career choice is realistic This student s attitude will be an asset to educational and career plans. 9. Your expectation of this student s academic success Your expectation of this student s career success D. Unusual circumstances or factors which you feel warrant special attention. E. In a class of students, this student ranks. F. Transcript of grades is ( ) attached ( ) to be forwarded immediately. Appraiser s Name Date Title Address Appraiser s Signature 6

7 The Lucille Harrison Charitable Trust Statement of Receipts vs Expenses Receipts Savings (Current or potential) Employment Parental or other contributions Grants/Scholarships. Loans.. Other (Please explain below).. TOTAL RECEIPTS... Expenses Tuition (Full Year). Room & Board (Full Year) Books & Supplies (Full Year) Fees (If any, full year). Miscellaneous (Please explain below) TOTAL EXPENSES.. LESS TOTAL RECEIPTS. NEEDED (SHORTFALL). 7

8 COUNSELOR SHOULD PLACE THIS PERMISSION NOTICE IN STUDENT S FILE I hereby give my permission to the respective high school and/or college I attend or plan to attend to release a copy of my transcript of grades, class rank, college board scores, and financial aid commitments offered to me as an enrolling student. I also agree to permit to share the information on my Lucille Harrison Charitable Trust Scholarship application, together with the supporting financial data, with any other student aid funding source to which I have applied. I further certify that the information contained in my application is complete and accurate to the best of my knowledge. Signature of Person Accessing File Applicant s Signature Date of File Access *Witness to Applicant s Signature *The witness to this application should be a person who can vouch for the validity of information contained on the student s application. You are, therefore, urged to find a witness who knows you well enough to support the statements you have made. 8