Marshall County Memorial Scholarship Fund Application Form PURPOSE: The Marshall County Memorial Scholarship Fund was founded by interested persons who wished to provide a means through which people could be memorialized or honored in a manner that would be beneficial to others. ELIGIBILITY: Any student in the graduating class of a high school in Marshall County, Tennessee, or any resident of the County who has completed high school (or its related equivalent) is eligible to enter competition for a scholarship from the Marshall County Memorial Scholarship Fund. The scholarship is for use by recipients attending an accredited junior college, senior college, university, professional or trade school. The award of the scholarship is based on a number of factors, with special emphasis on the applicant s character, personal merit, and background. DEADLINE: This application and the required enclosures must be filed with a member of the Marshall County Memorial Scholarship Fund s Scholarship Selection Committee by March 14, 2014 to be eligible for consideration. The County s High School Guidance Counselors will have information indicating persons with whom the applications should be filed. INSTRUCTIONS FOR COMPLETING THE APPLICATION: Complete the following information completely and accurately. Typewritten or computer generated applications are preferred over handwritten submissions. Handwritten copies must be in black ink. Applicants must provide the information requested as well as the required enclosures listed below. Incomplete applications will not be considered. Please do not include letters of reference the applicant is required to list three (3) references who will be contacted by the Selection Committee. It is preferred that only one of these references be a teacher at the applicant s high school. REQUIRED ENCLOSURES: (Omission of required enclosures will disqualify applicant from consideration.) 1. A copy of the SAT College Entrance Examination Board or ACT the American Testing program scores 2. A copy of a high school transcript or its equivalent.. Members of a graduating senior class should submit a transcript of courses completed through the first semester of their senior year. 3. Applicant s photograph. 4. A statement written by the Applicant giving, in 200 words or less, the reason for wanting this scholarship. 5. In the event Applicant is or has been a student at a college, university, or trade school, a transcript of courses taken through the previous semester before the submission of the application. References (Name address, and phone number): 1. 2. 3. Certification and Permission To the best of my knowledge, the information I have furnished in the attached application for the Marshall County Memorial Scholarship is true and correct. Permission is granted for the Selection Committee to have access to the requested information and to contact the references provided herein. (Applicant s signature and date) Parental Consent (if required): (Father s signature and address) (Mother s signature and address)
GENERAL INFORMATION: APPLICANT S FULL NAME SOCIAL SECURITY NUMBER APPLICANT S PERMANENT ADDRESS TELEPHONE DATE AND PLACE OF BIRTH CITIZENSHIP SCHOOLS ATTENDED (ninth through twelfth grade) HIGH SCHOOL GRADUATION DATE NUMBER OF STUDENTS IN CLASS RANK IN CLASS APPLICANT S EDUCATIONAL PLANS: Institution the applicant plans to attend: Enrollment status (full-time or part-time): Expected Major Field of Study: Career Goal: Actual amount of school tuition charges per semester or quarter (do not estimate, get costs from school): The coming year will be applicant s (1 st, 2 nd, 3 rd, 4 th ) year in college: Where will applicant live while attending school? (At home, on campus or other. If other, please give details) Estimated cost of room and board if on campus: APPLICANT S EMPLOYMENT ACTIVITIES: Have you held one or more jobs outside the home for four weeks or longer during the past school year and current school year to date? If yes, please list your employer(s): Applicant s approximate income before taxes last year. Include taxable and non-taxable income from all sources. (Mark only one): Less than $500 Approximately $500 to $1,500 Approximately $1,500 to $3,000 Approximately $3,000 to $5,000 More than $5,000 Does applicant have funds (i.e., savings accounts, trust funds, etc.) with which to pay college expenses? If so, please give the source and approximate value: Has applicant applied for or expect to receive (or been granted already) scholarship aid and/or loans from any other source? If so, please give details:
PARENTAL AND FAMILY DATA: Note; Self-supporting or married adults applying for scholarship aid should check here ( ) and supply information concerning yourself and, if applicable, your spouse, in the area below listed for father and mother. Father s full name, occupation, and employer: Condition of father s health: Father s income from any source (including alimony and child support): Mother s full name, occupation, and employer: Condition of mother s health: Mother s income from any source (including alimony and child support): Who is the custodial parent for the applicant? Father Mother Both In the event the parents are divorced, separated, or remarried, how much will the other parent contribute to the Applicant s education for the coming school year? Is there an agreement specifying this contribution to applicant s educational needs? Parents approximate combined income before taxes last year. Include taxable and nontaxable income from all sources (Mark one): Less than $10,000 Approximately $10,000 to $20,000 Approximately $20,001 to $30,000 Approximately $30,001 to $40,000 Approximately $40,001 to $50,000 Approximately $50,001 to $60,000 Approximately $60,001 to $70,000 Approximately $70,001 to $80, 000 Approximately $80,001 to $90,000 Approximately $90,001 to $100,000 More than $100,000 List the ages of other dependent children living at home (do not include applicant): List the ages and year in school for any other dependents in college or other postsecondary institution (do not include applicant): Will the parents help pay applicant s educational expenses if he/she does not get a scholarship? Explain any unusual financial circumstances:
SCHOOL ACTIVITIES: Indicate participation in each grade for leadership or membership positions in the following activities: 9 th 10 th 11 th 12 th Student Council Class Officer School Newspaper School Yearbook School and classroom related clubs (Science, Language, FFA/FHA, Band, FCA, 4-H, etc.) List Clubs: Service Clubs List Clubs: Interscholastic Athletics List sport and leadership position: State and National Awards and Honors: School/Local Awards and Honors: Community activities and volunteer service: