LOCAL SCHOLARSHIP – STUDENT APPLICATION

Read instructions carefully as you complete this form.

I. Application due May 6, 2008

Return to: Office Secretary

Applications are to be typed or downloaded from website

II. List the names of all local scholarships for which you are applying. (Vocational programs can be completed in 2 years or less. Academic programs require a 4-year degree).

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III. Transcript: Attach a photocopy of your high school transcript. Make no changes on the transcript.

IV. Autobiography: Write a brief autobiography, including your goals and future plans.

V. Student and Family Information:

1. Name__________________________________________

2. Address________________________________________

3. Parent/Guardian__________________________________

Address________________________________________

Telephone______________________________________

4. Post high school plans:

College or vocational school you plan to attend:_______________________________________________________________

Anticipated major in post high school training:______________________________________________________________

VI. List three references that the Committee may consult for further information. Only one reference may be a teacher.

Name Address Phone

VII. Activities Record: List the community and school activities you have participated in for the last three (3) years. Include work experience activities.

Grade 12:

Grade 11:

Grade 10:

List clubs you have actively participated in:__________________________________

_____________________________________________________________________

VIII. Anticipated Cost of College:

Name of College__________________________________________

Tuition & Fees____________________________________________

Books & Supplies__________________________________________

Room, Board, Transportation_________________________________

IX. Did you apply for financial aid through PELL or CalGrant?______

Note: The California student financial aid department defines financial need as the difference between what it costs to attend a particular college and what you and your family can contribute.

X. Financial Report:

1. Household Information:

a. Total number of family members in the household________

b. Number of family members presently in college________

2. Income and Expense Information:

a. Income earned last calendar year by: Father_________

Mother________

Student________

b. Father’s Employer____________________________________

Mother’s Employer___________________________________

Student’s Employer___________________________________

c. Non-taxable income last calendar year:

Social Security Benefits_______Parent”s:__________student’s

Other non-taxable income (child support, etc.)______________

Medical expenses not covered by insurance________________

Total U.S. Income Tax paid last calendar year______________

Total State Income Tax paid last calendar year______________

Any unusual financial circumstances______________________

The information contained on this scholarship application is used by the committee in making their selection and is considered confidential.

_____________________________________ ________________________

Signature of Applicant Date