MHS Scholarship Application form by xjw18681

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									                              MUSCATINE HIGH SCHOOL

                          SCHOLARSHIP APPLICATION FORM


All questions must be answered. Use black pen or type.

I. Personal Information

      Name __________________________________Date of Birth_______________

      Address_________________________________Telephone_________________

      Father’s Name___________________________Occupation________________
      Address_________________________________Employer_________________
                                              Telephone_________________

      Mother’s Name__________________________Occupation________________
      Address_________________________________Employer_________________
                                              Telephone_________________

      Dependent family members (list names and relationship)_________________
      __________________________________________________________________


II. High School Information

      Academics

      Rank in Class ____________                  Grade Point Average ___________

      List your second semester senior courses.

      1.                                 4.                                7.

      2.                                   5.

      3.                                   6.


      School Activities
      (include offices and honors)

        Grade 9               Grade 10              Grade 11          Grade 12
      ____________          ____________          ____________      ____________
      ____________          ____________          ____________      ____________
      ____________          ____________          ____________      ____________
      ____________          ____________          ____________      ____________
      ____________          ____________          ____________      ____________
      ____________          ____________          ____________      ____________
      ____________          ____________          ____________      ____________
      Community Activities and Work Experience
      (Include hours spent per week)


        Grade 9              Grade 10            Grade 11             Grade 12
      ____________          ____________        ____________         ____________
      ____________          ____________        ____________         ____________
      ____________          ____________        ____________         ____________
      ____________          ____________        ____________         ____________


III. Post Secondary Plans

      What school do you plan to attend (Fall, 2010)?___________________________

      Major___________________________ Have you been accepted?_____________

      How much will this school cost per year?________________________________

      Have you filed a FAFSA?_____________________________________________

      How much money will you personally provide each year?
      ___________________________________________________________________

      How much will your family provide?____________________________________

      Do you expect to do part -time work?____________________________________

      Have you been awarded any other scholarships, grants and or loans? If yes please
      list the award and amount.

      ______________________________________________________________________

      ______________________________________________________________________



IV. Essays

      In order for the selection committee to become better acquainted with you, please
      answer 2 of the following 3 essay questions. Limit your response to either one,
      typewritten page or two, handwritten pages per question.

          1. What significant experience has taught you a valuable or meaningful lesson?

          2. What do you consider an important issue (personal, local, national)? Why?

          3. Discuss your college/career choice. What factors influenced your decision.
V. Recommendations

      List three MHS teachers whom YOU will ask to complete the student rating sheet.
      (Note – counselors MAY NOT be listed.)

      1._________________________________________________________________

      2._________________________________________________________________

      3._________________________________________________________________

      List three personal references other than high school personnel.
      Name            Telephone             Address             Occupation/Employer

      1.__________________________________________________________________

      2.__________________________________________________________________

      3.__________________________________________________________________

VI. Signature

      To the best of my knowledge I have provided information in this application which
      is accurate.

      _________________________         _________________________________________
      Date                                    Signature

								
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