290 S. STATE ST., UKIAH, CA 95482
468-9882, 468-5529 FAX
SCHOLARSHIP APPLICATION FORM
APPLICATION FOR THE
VIOLA L. AND OSCAR A. ALLEN SCHOLARSHIP
Name: _______________________________________________________________
Home address: _________________________________________________________
Home phone: ________________________ Cell phone: _______________________
Email address: __________________________________________________________
Father’s/Guardian’s name: ________________________________________________
His occupation: _________________________________________________________
Mother’s/Guardian’s name: ________________________________________________
Her occupation: _________________________________________________________
Number of dependent children in family (include self, if applicable): ______________________
What college/university are you planning to attend?
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Field of interest: _____________________________________________________________
SUBMIT THE FOLLOWING NO LATER THAN APRIL 7, 2011:
1. A completed Application Form, Essay, and Income Form
2. A resume of work and extracurricular involvement
3. A copy of your high school transcript
4. A copy of your college transcript, if applicable
5. A minimum of two letters of recommendation for both character and potential for career success
from teachers, counselors, and/or employers.
Viola L. and Oscar A. Allen Scholarship Student Application
In essay form, please answer the following questions (attach additional pages if
necessary):
What are your long-term educational and/or career goals?
What is your academic plan for attaining these goals?
What are your reasons for establishing these goals?
What experiences in high school or college have enabled you to investigate your field of
interest?
Why are you applying for this scholarship?
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Viola L. and Oscar A. Allen Scholarship Student Application
Income Statement
[Annual]
In U.S. Dollars
Wages
Applicant’s Gross wages (per most recent W-2)
Parents’ wages (if applicable)
Total Income
Other Income
Interest
Dividends
Loans
Other Scholarships/Grants
Additional Support (from parents, spousal or child support)
Other (specify)
Other (specify)
Total Household Income
Number of Dependents
Expenses
Rent/Mortgage payment
Utilities
Transportation
Car payment
Car Insurance
Medical/Dental
Tuition
Charitable contributions
Property Tax
Income Tax
Legal and Professional Fees
Licenses and Fees
Entertainment
Homeowners' Dues
Homeowners'/Renters' Insurance
Food
Clothing
Car Repairs & Maintenance
Books/Supplies
Tuition (dependents)
Home Repairs & Maintenance
Other (Medical)
Other (specify)
Other (specify)
Total Expenses
Net Operating Income
Total Student Loan Debt
Subsidized Loan
Unsubsidized Loan
Total Loan Debt