The Richard & Rose Dermenjian Armenian Scholarship Scholarship Application A. Personal Information: Name: Date: Phone Number: E-mail address: Social Security Number: _ Date of Birth: Male Female Marital Status: Single Married Church Affiliation: Phone Number: B. Citizenship Status: United States Citizen. Permanent Resident, but citizen of. (Identify Country of Citizenship) Other. Please describe. C. Education: High School Name of School: Date of Graduation: Cumulative Grade Point Average: Rank in Class: SAT scores each time taken: 1. Please describe all of the extra curricular activities in which you participated:
2. What were your contributions and your position with regard to these activities: 3. What awards, honors or recognition have you have you received? Please describe each: 4. Describe any community service you performed in the last twelve (12) months. Name of the 4 year accredited college you plan to attend: Intended Major: Telephone: Anticipated Date of Graduation 2
Name of College: Telephone: College Information (To be completed by applicants who have attended at least one semester of a 4 year accredited college) Major: Cumulative Grade Point Average to date: Rank in class: Anticipated Year of Graduation: Current College Year: Freshman Sophomore Junior Senior 1. Please describe all of the extra curricular activities in which you participated: 2. What were your contributions and your position with regard to these activities? 3. What awards, honors or recognition have you have you received? Please describe each: 4. Describe any community service you performed in the last twelve (12) months. D. Proof of Armenian Heritage Please attach two (2) letters of proof (such as letters from a priest or other Armenian community leader etc.) Please include address and phone numbers. Letters of Reference Submit three letters of recommendation from teachers, guidance counselors, etc. Please include address, phone numbers and relationship 3
E. Financial Information Have you applied for other scholarship aid? Have you previously applied for this fund? Have you received or been approved for other scholarship aid? If so, name the scholarship, amount awarded and date of award: Have you applied for financial aid? yes / no (please circle). If yes, please provide copies of application form. Father s Name: Phone: Occupation: Email: Also include name, address and phone number of employer: Mother s Name Phone: Occupation: Email: Also include name, address and phone number of employer: Gross annual income of parents: Gross annual income of applicant: Names of Siblings: 1. Age 2. Age 3. Age 4. Age Number of siblings in college and receiving assistance from parents and other sources: 4
Applicant s Employment What has your most recent employment record been: summer part-time full-time Most Recent Employer s Name: Phone: Title of position held: Dates of employment to Source of Funds: Self: Student Loan: Grants: Parents: ROTC: Other: TOTAL Applicant Cost Estimates: Tuition: Room: Board: Books: Personal: Other: TOTAL Your College Funding Plan Source: Source: 5
F. Essay Questions (Please provide your answer to one (1) of the essays below on a separate sheet of paper. Your essay response should be approximately 500 words.) 1. What has your Armenian heritage meant to you and how have you contributed to the Armenian Community? 2. How will a scholarship from the Richard & Rose Dermenjian Armenian Scholarship Foundation enable you to contribute to the Armenian community? 3. What does college education mean to you? 4. What kind of impact would you make on the world with your education? G. Verification I hereby make application to the Richard & Rose Dermenjian Armenian Scholarship Foundation and hereby state that all the above information is true to the best of my knowledge and that if selected, I will comply with the by laws, rules and regulations of the foundation. Scholarship Application Deadlines: Scholarship applications will be accepted between now and June 20, 2016 for the 2016 Fall Semester. Signature of Applicant: Date: Please mall application to: The Richard & Rose Dermenjian Armenian Scholarship Foundation, P. O. Box 547, Media, PA 19063 6
Application Checklist 1. Recent Photo (optional). 2. High School transcript; or 3. If currently enrolled in college, college transcript. 4. Two (2) letters of proof of Armenian Heritage (example: letter from a priest or other Armenian community leader). 5. Two (2) letters of recommendation from teachers, guidance counselors, etc. (include address, phone numbers and relationship to applicant). 6. If you have previously applied for any other financial aid, please provide copies of all application forms. 7. Copy of tax returns (1040) for previous 3 years for applicant and parents, or if married, include 1040 of spouse as well. 8. Response to Essay. If you have applied for this scholarship before, please select an essay that you have not responded to previously. 9. Signed authorization which allows us to contact the school on your behalf (included in this packet). 10. If you are currently enrolled in college, please attach your invoice from that school. 11. As of January 1, 2012, your application is limited to one application per year. If you apply for the Fall 2012 semester, you cannot apply again in December for the Spring 2012 semester. 7
AUTHORIZATION (Date) (Fill in name of your school) (address of your school) Re: Student Name: Student ID # Dear Financial Aid Representative: This letter will authorize you to release information to the Richard Dermenjian Charitable Trust, which established the Richard and Rose Dermenjian Scholarship. I have applied for a scholarship with the Trust and they may contact you to confirm my eligibility and request information about me. The contact information for the scholarship is: Richard and Rose Dermenjian Armenian Scholarship P.O. Box 547 Media, PA 19063 If a representative from the Richard and Rose Dermenjian Armenian Scholarship calls you, please accept this letter as authorization from me to answer questions or provide information to them. Very truly yours, Name of Student Street Address City, State 8