Door County 2018-19 Common Scholarship Application...1. APPLICANT’S FULL NAME:. Door County...
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1. APPLICANT’S FULL NAME: __________________________________________________________________________ Door County 2018-19 Common Scholarship Application This Common Scholarship Application is designed to simplify the application process for Door County students. Download this application, save a copy, and edit it as often as needed. Submit this application (and any other requested information) to each scholarship program to which you want to apply. Some scholarship programs require additional materials such as letters of recommendation or a unique essay. Please note that while many local scholarship programs accept this application, NOT all of them do. Be sure to closely review the application instructions for each individual scholarship before applying. NAME OF SCHOLARSHIP TO WHICH THIS APPLICATION IS BEING SUBMITTED: __________________________________________________________________________________________________ 2. APPLICANT INFORMATION Mailing Address: ____________________________________________________________________________________ City, State, Zip: _____________________________________________________________________________________ Door County Resident: Yes No Resident of the City, Village or Town of: ________________________ Telephone: ______________________ Email: __________________________________________________________ High School: ________________________________________ Month & Year of Graduation: _____________________ 3. PARENT INFORMATION Father’s Name: __________________________________ Mother’s Name: _________________________________ Occupation: ____________________________________ Occupation: ____________________________________ Employer: ______________________________________ Employer: ______________________________________ Telephone: _____________________________________ Telephone: _____________________________________ Email: _________________________________________ Email: _________________________________________ Parent’s Marital Status: Married to each other Divorced from each other Never married to each other Widowed Both deceased With whom do you primarily reside: With both parents Mother’s home Father’s home Independent Guardian (Name and Relationship: _____________________________________________________) 4. CERTIFICATION By signing (or typing) my name below, I declare under penalty of perjury that all statements contained in this application and any accompanying documents are true and correct to the best of my knowledge. ______________________________ _________ ______________________________ _________ Applicant’s Signature Date Parent’s or Guardian’s Signature Date This signature is required if applicant is claimed as a dependent for tax purposes. 2018 1130
Transcript of Door County 2018-19 Common Scholarship Application...1. APPLICANT’S FULL NAME:. Door County...
1. APPLICANT’S FULL NAME: __________________________________________________________________________
Door County 2018-19Common Scholarship Application This Common Scholarship Application is designed to simplify the application process for Door County students. Download this application, save a copy, and edit it as often as needed. Submit this application (and any other requested information) to each scholarship program to which you want to apply. Some scholarship programs require additional materials such as letters of recommendation or a unique essay.
Please note that while many local scholarship programs accept this application, NOT all of them do. Be sure to closely review the application instructions for each individual scholarship before applying.
NAME OF SCHOLARSHIP TO WHICH THIS APPLICATION IS BEING SUBMITTED:
__________________________________________________________________________________________________
2. APPLICANT INFORMATION
Mailing Address: ____________________________________________________________________________________
City, State, Zip: _____________________________________________________________________________________
Door County Resident: Yes No Resident of the City, Village or Town of: ________________________
Telephone: ______________________ Email: __________________________________________________________
High School: ________________________________________ Month & Year of Graduation: _____________________
3. PARENT INFORMATION
Father’s Name: __________________________________ Mother’s Name: _________________________________
Occupation: ____________________________________ Occupation: ____________________________________
Employer: ______________________________________ Employer: ______________________________________
Telephone: _____________________________________ Telephone: _____________________________________
Email: _________________________________________ Email: _________________________________________
Parent’s Marital Status: Married to each other Divorced from each other Never married to each other Widowed Both deceased
With whom do you primarily reside: With both parents Mother’s home Father’s home Independent Guardian (Name and Relationship: _____________________________________________________)
4. CERTIFICATIONBy signing (or typing) my name below, I declare under penalty of perjury that all statements contained in this application and anyaccompanying documents are true and correct to the best of my knowledge.
______________________________ _________ ______________________________ _________ Applicant’s Signature Date Parent’s or Guardian’s Signature Date
This signature is required if applicant is claimed as a dependent for tax purposes.
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5. HIGH SCHOOL ACADEMIC PERFORMANCE
Cumulative Grade Point Average: ____________________ Class Rank: ________________ Class Size: _____________
Does your high school use a weighted GPA (such as for honors or advanced placement courses): Yes No
Number of Advanced Placement, Honors, or Advanced Courses: Senior Year: _____________ Junior Year: __________
ACT Composite: _________ SAT Critical Reading: ____________ SAT Math: ____________ SAT Writing: ____________ Include all scores if you have taken both exams.
6. COLLEGIATE ACADEMIC PERFORMANCE (if currently enrolled in college)
College: ___________________________________________ Month & Year of Graduation: _____________________
Cumulative Grade Point Average: _________________ Class Rank: ________________ Class Size: _____________ If applicant’s college uses a weighted scale or anything other than a 4 point scale, attached a separate sheet explaining system.
7. SIGNIFICANT CO-CURRICULAR ACTIVITIES (clubs, sports, student government, etc.)Co-Curricular Activity Leadership Position (if any) Total Hours Years Involved
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
8. SIGNIFICANT COMMUNITY VOLUNTEERISM (church, charity work, scouting, etc.)Volunteer Activity Leadership Position (if any) Total Hours Years Involved
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
____________________________ __________________________ ___________ Fresh Soph Jr Sr
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9. SIGNIFICANT PERSONAL INTERESTS AND HOBBIESPersonal Interest or Hobby Years Involved
_________________________________________________________ Fresh Soph Jr Sr
_________________________________________________________ Fresh Soph Jr Sr
_________________________________________________________
Total Hours
___________
___________
___________ Fresh Soph Jr Sr
10. SIGNIFICANT SCHOOL OR COMMUNITY AWARDSAward Awarded By Years Awarded
______________________________________ _____________________________ Fresh Soph Jr Sr
______________________________________ _____________________________ Fresh Soph Jr Sr
______________________________________ _____________________________ Fresh Soph Jr Sr
______________________________________ _____________________________ Fresh Soph Jr Sr
______________________________________ _____________________________ Fresh Soph Jr Sr
11. STUDENT WORK EXPERIENCEMost recent employer: _______________________________________________________________________________
Job Title: ________________________________________ Average Hours/Month: ________ Hourly Wage: $_________
From (month/year): ________________________________ To (month/year): ________________________________
Next most recent employer: ___________________________________________________________________________
Job Title: ________________________________________ Average Hours/Month: ________ Hourly Wage: $_________
From (month/year): ________________________________ To (month/year): ________________________________
12. COLLEGE INFORMATIONAnticipated Undergraduate Major or Program of Study: _____________________________________________________
Type of School: Four-Year College or University Technical or Community College Junior College Other (Please specify: _____________________________________________________________________)
Level of Attendance: Full-Time Part-Time
1st choice or If applicable, current school: ______________________________ 2nd choice school: ______________________________
City, State: ______________________________ City, State: ______________________________
Next year’s anticipated expenses at this school: and at 2nd choice school, if applicable:
Tuition: $_____________________________ Tuition: $_____________________________
Room & Board: $_____________________________ Room & Board: $_____________________________
Books & Supplies: $_____________________________ Books & Supplies: $_____________________________
Total: $_____________________________ Total: $_____________________________
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13. FINANCIAL INFORMATIONPercentage of college expenses to be paid by: You_________% Father_________% Mother_________%
Other_________% (please explain: _____________________________________________________________)
Do you plan to live on campus? Yes No Do you plan to work while attending school? Yes No
Ages of siblings living at home: ____________________ Ages of siblings attending college next year: ________________
List all scholarships, grants or awards (including dollar amounts) that you know you will receive for next school year:
Briefly explain any unique financial circumstances (if any) that impact your ability to pay for college:
14. EDUCATIONAL AND CAREER GOALSIn the space provided, briefly discuss your post-secondary educational plans and possible career goals.
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15. PERSONAL ESSAYIn the space provided, select a person you admire, describe why you admire this individual, and how he or she hasinfluenced your life.
16. SUPPORTING DOCUMENTSPlease attach the following supporting documents to this application:Current high school students, submit an official high school transcript verifying GPA, class rank, and test scores.Current college students, submit an official college transcript and current course schedule.Returning students not currently enrolled in any educational institution, submit an official transcript from the lastinstitution you attended (high school or college) and a resume showing your work history since you last were in school.
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17. ADDITIONAL INFORMATIONPlease refer to the instructions of each individual scholarship program to determine if it requires additional informationor other documents. If additional information is required (such as an essay, an explanation of volunteer work, etc.), youmay attach additional pages or simply provide the information in the space below.
The Door County Scholarship Network is a program of the Door County Community Foundation, Inc. The Door County Common Scholarship Application was created to simplify the application process for students. However, this application will be submitted to independent third-party scholarship programs of your choosing. The actions of such independent scholarship programs is not within the control of the Community Foundation, and thus the Community Foundation cannot and will not take responsibility for their actions and does not take responsibility for the collection or use of personal data by any independent third-party scholarship program.
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