Liberty Bank Foundation Academic Grant Application

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Liberty Bank Foundation Academic Grant Application Powered By Docstoc
					                                                                                Scholarship Application


This application must be submitted by a guidance counselor, teacher, or administrator. Please attach the
following documents:
       The student’s official transcript
       A copy of the Student Aid Report (SAR) – please include all pages
       A letter of recommendation from one of the student’s teachers (other than the person submitting
        this nomination)
       A 500-1000 word essay written by the student on a topic of his/her choice
The completed and signed application, with all requested supporting documents, should be sent to the
following address no later than April 5, 2012, in order to be considered for the scholarship:


                                            Liberty Bank Foundation
                                           2012 Scholarship Program
                                                 P.O. Box 1212
                                             Middletown, CT 06457


General Information
Name of High School:

Name and title of counselor, teacher, or administrator submitting this application:

Student’s Name:               Date of birth:        /        /

Street Address:                                    City:                         Zip:

Home Phone: (             )        -               Cell Phone (          )        -

Work Phone: (         )            -               E-mail:

Grade point average: Senior year                   Junior year                Sophomore year

SAT scores:       Math                  Verbal               Writing

College or university student plans to attend:

City and state of college or university:

Type of College:     Liberal Arts              Technical         Vocational      Business

Major or course of study (if known):

Student’s career objective:
Financial Information

Father’s occupation:             Father’s 2011 income:

Mother’s occupation:             Mother’s 2011 income:

Total number of children in household (including student)

Number of children in household attending college full-time during 2012-13 (including student)

Is student employed?     Yes     No    If yes, list employer’s name:

Student’s position:      Student’s 2011 income:



Student Qualifications

Please describe the student’s extracurricular and volunteer activities, including the length of involvement in
each and the approximate amount of time spent per week or month on each activity. (If you provide this data
on a separate sheet, please fill in “see attached” below.)



Please explain why you believe this student should be considered for our scholarship program. Include
information on the student’s educational and career goals, financial need, academic performance,
community service, and any other data you feel are relevant. (If you provide this data on a separate
sheet, please fill in “see attached” below and be sure to sign this sheet where indicated.)



______________________________________________________                                   ________
Signature of counselor, teacher, or administrator submitting this application              Date

My child,       , has my permission to participate in the Liberty Bank Foundation Scholarship program. I
understand that this form serves only to enter my child in the scholarship selection process, and does not
constitute a promise of a scholarship.


______________________________________________________                                   ________
Signature of parent or guardian of student being nominated for scholarship                Date

Name of parent of guardian:


I wish to participate in the Liberty Bank Foundation Scholarship program and agree to abide by the
guidelines of the program as set forth in the Liberty Bank Foundation Scholarship Guidelines.


______________________________________________________                                   ________
Signature of student being nominated for scholarship                                       Date

				
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