Application for Scholarships

APPLICATION FOR SCHOLARSHIPS

Administered by

ALLEGANY COUNTY AREA FOUNDATION

Former Rushford School District? Yes No High School________________________

Part I: Personal Information Social Security # ____ ____ ____

Name: Phone:

Please print or type

Temporary Address:

Permanent Mailing

Street Address:

Legislative District: I, II, III, IV, V (please circle) Township:

Graduation Date:

College you plan to attend next year:

College now attending:

College graduation date:

College major anticipated:

Name of parent(s) or guardian(s) with whom you reside:

List full or part-time employment

Employment Dates

List special recognition, honors, scholarships, or awards you have received:

List extracurricular and community or volunteer activities (clubs, organizations, memberships, athletics, offices held, projects)

Part II: Financial Information: Submit only if you wish to be considered for Mary Bishop, Alfred Wood, William Farnsworth or Kirby Jensen Scholarships. Applicants must submit both a copy of both parents’ Federal Income Tax returns and their own income tax return if filed, or a FASFA application and determination. (Only students who qualify as independent students under federal guidelines may claim financial independence.)

Part III: Estimated College Expenses (annual basis)

Tuition and Fees:_____________________ Room and Board__________________ Other__________

How do you plan to meet these expenses:

Detail any unusual circumstances which affect your need for financial assistance:

Part IV: Essay

Essay must be typed and be no more than 400 words in length.

Name someone in your school career who has made a positive influence on your life (teacher, non-teacher, staff member, administrator or any school employee) and describe the contribution he or she made.

Part V: Letters of Recommendation

One letter of recommendation should be from a person who knows you well (administrators, teachers, employers, community leaders or clergy). Please list reference:

Part VI: Transcript

An official transcript must include grades from the first semester of the current school year.

Part VII: Affirmation

I hereby affirm that the information herein is correct, and I promise to notify the Allegany County Area Foundation, Inc., immediately of any significant change. I agree that any award made to me may be revoked if I do not meet the qualifications.

Date____________________ Signature______________________________

It is the applicant’s responsibility to see that all

required documents have been submitted.

Incomplete applications cannot be considered.

Checklist

_____This Application

_____IRS return(s) if required

_____400 word essay

_____One letter of recommendation

_____Official Transcript