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SOUTH CENTRAL COUNSELING ASSOCIATION

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					         SOUTH CENTRAL COUNSELING ASSOCIATION SCHOLARSHIP
                        2011-2012 Application

  ***Applicants MUST be pursuing an education degree at the post-secondary level***



Applicant’s Name: __________________________________________________

Address: ____________________________________________________________
                          Street or P. O. Box

Phone number: (    ) _____________              Date of Birth: _____________________

Father’s Occupation ________________            Place of Employment ______________

Mother’s Occupation _______________             Place of Employment ______________

Gross Family Income ________________

Number of siblings at home ___________          Ages __________________________

Number of siblings in college __________        Grade Level(s) __________________

Have you worked during the school year? ____       Avg. number of hours worked ____

ACT Composite ____________________              GPA (4.0 Scale)   _______________


List honors or Advanced Placement courses you have taken.




List your major accomplishments, awards, honors or recognitions during high school:
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      SOUTH CENTRAL COUNSELING ASSOCIATION SCHOLARSHIP
                       2011-2012 Application

List school and community activities during high school:




List scholarships already awarded including amounts if known:
*Please note if a Governor’s Scholars or Governor’s School for the Arts participant




Please write a paragraph that explains what circumstances place you in financial need.




Please tell in 500 words or less who or what influenced your decision to go into the field
of education.
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             SOUTH CENTRAL COUNSELING ASSOCIATION SCHOLARSHIP
                            2011-2012 Application



What is the name and address of the Kentucky College or university you will attend
during the 2012-2013 school year?


Name of school ____________________________________________________

School’s Mailing address
                              ________________________________________________
                                             Street or P. O. Box


City                                 State                                  Zip



ATTACH THE FOLLOWING TO YOUR APPLICATION:
  1) A copy of your letter of acceptance from the college you plan to attend
  2) Scholarship award letter/form if applicable
  3) An official copy of your 7-semester high school transcript with attendance
  4) One letter of recommendation from school or community leader

          Note:     The following areas will be viewed more critically for this
           scholarship: financial need, previous scholarships awarded, GPA, college
           entrance scores, and area of college major (should be educationally-
           related).

          If you need extra space for any application items, please feel free to attach a
           copy. Please make sure you make reference to the item you are completing on
           the attached sheet.

          THE COMPLETED APPLICATION IS TO BE GIVEN TO YOUR COUNSELOR.
           PLEASE DO NOT MAIL IT YOURSELF.

          COUNSELORS, mail them to the current SCCA Scholarship Chair.
           Postmark deadline is March 15th. PLEASE MARK TO ATTENTION OF
           SCCA SCHOLARSHIP CHAIR!

To be completed by school counselor:

Due Date: __________________________

SCCA member: _____________________ (An SCCA member must be employed in
the school system in order for the high school to participate in the scholarship program.
School counselor must supply this person’s name.)

				
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