Max Way Scholarship Application2012 by s90P2am8

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									           MAX WAY SCHOLARSHIP APPLICATION
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ELIGIBILITY
 1. Resident of one of the following counties: Athens, Gallia, Hocking, Jackson, Lawrence,
    Meigs, Pickaway, Pike, Ross, Scioto, Vinton, or Washington
 2. Have an Ohio GED or high school diploma
 3. Attended an ABLE program in one of the above counties within the last 12 months
 4. Will enroll in postsecondary education or training within six months of receiving
    scholarship

PERSONAL INFORMATION

 Name

 Address

 Telephone

 Email address

 Date of birth

EDUCATIONAL BACKGROUND

 ABLE program attended
 within the last year
                                                  (Program name and location)

 High school/GED
 graduation date                                  GED Score
                                                                        (Enclose a copy of diploma)
 High school name/location
 or GED Test Center

EDUCATIONAL PLANS

 College, university, or
 training you plan to attend

 Location or campus

 Course of study                                          Starting date

EMPLOYMENT

 Employer

 Position or job

 Monthly earnings      $                   Spouse’s monthly earnings            $

 If unemployed,
 source of income                                     Monthly earnings          $

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FINANCIAL INFORMATION
(this section may be replaced by a statement of need)


Number of dependents                          Number enrolled in college

                                              (include rent/mortgage, food, clothing,
Monthly expenses            $                 transportation, utilities, medical, other)

Are you receiving any other
scholarship or tuition assistance?         Yes      No     If yes, list amount        $


PERSONAL COMMENTS

On an accompanying sheet of paper, please write a statement of not more than 250
words stating:

   1.   Your educational goals
   2.   Honors or special recognition you have received
   3.   Work experience (paid or volunteer)
   4.   Why you believe you are a strong candidate for this scholarship


LETTERS OF RECOMMENDATION

Two letters of recommendation, at least one from an Able instructor, must be
attached to this application.


SIGNATURE AND VERIFICATION

The information submitted on this application is true and complete. I grant permission to
the OAACE Scholarship Committee to verify such information and contact the listed
agencies.


        Signature _____________________________________                     Date ____________



                The application must be postmarked by March 9, 2012

                                MAIL THIS APPLICATION TO:
                                          Marie Barada
                                Ross County ABLE/GED Program
                                        40 West 5th ST
                                     Chillicothe, OH 45601
     OR FAX TO: 740–779-9609 OR Email to: marie.barada@pickawayross.com
    Contact Marie Barada with any questions 740-779-2035 or marie.barada@pickawayross.com


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Use this checklist to verify packet submitted:

_____ Application Form (3 pages)

_____ Personal Comments

_____ Letter of Recommendation, ABLE Instructor

_____ Letter of Recommendation, other

_____ Copy of diploma


Postmark Date_______________________________

Received by_________________________________




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