Turner Family Scholarship Application by frr13902

VIEWS: 17 PAGES: 8

									                          Community Foundation of Middle Tennessee, Inc.

                                            TURNER FAMILY
                                        SCHOLARSHIP APPLICATION
                                                               Instructions
                                                  (Read very carefully and follow exactly)

Student Name
   Mr.   Ms.
                    Last Name                                       First Name                                        MI

INSTRUCTIONS: Complete all pages of the application.

    If you are a high school student, make sure a School Official/Guidance Counselor fills out the necessary section on the School
     Record page and submit an official high school transcript.

    If you have graduated from high school, or are a one-semester freshman, or have never been enrolled in college, you must attach a
     copy of your high school transcript.

    If you are currently enrolled in college, you must attach a copy of your official college transcript. If you have only been enrolled
     for one semester, please submit whatever school record available.

    If it is the policy of the school you attend not to give official school records to students, then these records may come directly
     from the school providing they arrive before the deadline. School Records not received by the deadline will be considered
     incomplete and will not be reviewed.

    You must have two (2) Appraisals. ALL Appraisals should be given to you by the Appraisers in a sealed envelope. You should
     send the envelopes to The Community Foundation unopened. Do not send separately. If the appraiser sends your appraisal
     separate from your application, then it must arrive by the deadline or your application will be considered incomplete and will not
     be reviewed.

    Website generated transcripts or faxed transcripts are not official and are therefore unacceptable.

                PLEASE BE SURE THE FOLLOWING MATERIALS ACCOMPANY YOUR APPLICATION:

1.   Completed Application.
2.   Most recent high school transcript and/or college transcript (where applicable, sealed in a separate envelope).
3.   Two (2) Applicant Appraisals in envelopes sealed by the Appraisers.
4.   All supplemental forms from the Scholarship Application.
5.   Copy of the page from your Student Aid Report that shows Expected Family Contribution (EFC) as a result of filing FAFSA.

PLEASE NOTE: Incomplete applications and applications that arrive after the deadline will not be reviewed.
                          Award notices will be sent to your permanent mailing address.


                                            DEADLINE FOR APPLICATION:
                             MARCH 15, JULY 3, and NOVEMBER 3 AT 4:30 P.M. CENTRAL TIME

                                                       Submit applications to:
                               Scholarship Committee – The Community Foundation of Middle Tennessee
                                       3833 Cleghorn Ave Ste 400 – Nashville, TN 37215-2519
                                   (615) 321-4939 – (888) 540-5200 toll-free – (615) 327-2746 (fax)
                                                      Website: www.cfmt.org



                                                                                                                                            1
                                                    PERSONAL INFORMATION
                                       Complete this application on a computer from our website at www.cfmt.org

Student Name
   Mr.   Ms.
                     Last Name                                               First Name                                         MI

Mailing Address
Address
City                                               County                                        State                          Zip
Home Phone (include area code)                                          Work Phone (include area code)
Cell Phone (include area code)
Birthdate (mm/dd/yyyy)                                 Social Security Number                          Gender                       Male    Female
Email address: for office use only by The Community Foundation staff

Permanent Address (if different from above) Award letter will be sent to this address.
Address
City                                            County                                          State                           Zip
Home Phone (include area code)                                         Work Phone (include area code)

Are You A
   G.E.D. Graduate                                    High School Senior                              High School Graduate, Never Enrolled in College
   Undergraduate Student (ages 17-24)                 Undergraduate Student (ages 25+)                Graduate Student

High School                                                                                    Graduation Date (mm/yyyy)
City                                                                                                               State

MARK APPROPRIATE CHOICE
Level you will be entering in college:           Freshman               Sophomore                      Junior         Senior               Graduate
College/university you plan to attend:
Location of College/University:             City                                                                            State
Main Campus or a Satellite Campus:           Main     Satellite (If satellite, list location city & state) City                             , State
This school is a:     4yr college/university      2yr college        seminary           vocational/technical        Other
Degree you will be pursuing:         AA        AS         BA          BS          MA              Graduate        Other
Field of study
Will you be enrolled:
   Full-time (12 hours or more)        How much is tuition? $
    Part-time or more (6-11 credit hours) How many hours are you taking?                How much will it cost to take these classes? $
    Less than half-time (Less than 6 hours) How many hours are you taking?              How much will it cost to take these classes? $
Will you live:            on campus             off campus                 with parents               Other
Have you applied for other scholarships?          YES        NO
Have you received other scholarships?             YES        NO
If yes, please list from whom and how much:


If you are a resident of the State of Tennessee, will you qualify for the Tennessee HOPE Scholarship?                YES            NO

Activities/Work Experience (attach additional sheet if necessary)
List all community and school activities and work experiences in which you have participated. Include sports, student government, volunteer
projects, paid employment, etc. within the last three years.

Activity                                                           How Long?                                        Special Honors
                                                                      to
                                                                        to
Employer                                                           How Long?                                       Job Description
                                                                      to
                                                                        to
                                                                                                                                                        2
                                                       STUDENT ESSAY

Student Name                                                                              Social Security Number


Compose an essay that explains your educational plans and how those plans will lead to your chosen career. How did you choose that career
and who or what influenced your decision? Your essay will be a significant part of your applications, so please give it considerable thought.
Use only the space provided below; no handwritten essays, please. Do not add additional sheets.




                                                                                                                                           3
                                                 OFFICIAL SCHOOL RECORD
Student Name                                                                                       Social Security Number

TO ALL APPLICANTS:
Sign below and give this form to your School Official/Guidance Counselor. Have him/her complete the Official School Section below and
attach a copy of your current transcript. The School Official/Guidance Counselor should place both of them in a sealed envelope and should
sign the seal for security. Enclose the unopened envelope in the completed application as you forward it to The Foundation.

TRANSCRIPT SUBMISSION
         High school seniors and students who have completed less than one full semester of postsecondary education must include a high
          school transcript of grades and have the section below completed by the appropriate school official.
         Students currently enrolled in college must include recent college transcript of grades. You DO NOT have to complete the Official
          School Record section below. Website generated transcripts are not official documents and therefore are not acceptable. Request your
          transcript early, it may take several weeks.
Your transcripts can come directly from your school if it is the policy of that institution not to give official documents to students. Transcripts must
arrive before the deadline or your application will be viewed as incomplete and will not be reviewed.

                                                          OFFICIAL SCHOOL RECORDS
Please complete the information below. An official school transcript must accompany this student’s application. The records can come directly from
the school if it is the policy of that institution not to give official documents to students. School records must arrive by the deadline or the application
will be viewed as incomplete and will not be reviewed. You should place both the School Record and the Appraisal form in a sealed envelope and
sign the seal for security. Return the envelope to the student for inclusion in the completed application that is forwarded to The Community
Foundation. Please make sure the transcript is readable AND includes a class schedule for this year. Website generated transcripts are not official
documents and therefore are not acceptable.

Check one:                Public High School                Private High School                  Special/Magnet School            Home School
Student ranks                  in a class of            .     This rank is      weighted       unweighted     How many students share this rank?
If a precise rank is not available, please indicate rank to the nearest tenth from the top                        .    Total in Class
Cumulative GPA                                 on a                          scale, covering a period from                    to                          .
This GPA is        weighted      unweighted.              The school’s passing mark is                                                                    .

Standardized Test Scores:
ACT: Date Taken                          Composite Score
SAT: Date Taken                            Verbal              Math
If this student is a resident of the State of Tennessee, would he/she qualify for the Tennessee HOPE Scholarship?           YES        NO

                               TO BE COMPLETED BY SCHOOL OFFICIAL/GUIDANCE COUNSELOR
                                                  VERIFICATION OF STUDENT RECORD
I certify that all the information on this form is true and complete to the best of my (our) knowledge. If asked by any authorized official of The
Community Foundation of Middle Tennessee, I (we) agree to give documentation for information given on this form.

Name                                                                              Title                                                Date
School
Address
City                                          State                 Zip                       Email
Signature                                                         Phone                                  Fax


                                                                   CERTIFICATION
To comply with the provisions of the Family Educational Rights and Privacy Act of 1974, permission is hereby given to school officials to release
the secondary school record and other requested information for consideration with this scholarship application.

APPLICANT SIGNATURE                                                                                     DATE

PARENT (SPOUSE) SIGNATURE                                                                               DATE


                             ALL DOCUMENTATION SHOULD BE SUBMITTED BY THE DEADLINE.



                                                                                                                                                          4
                                               FINANCIAL AID ASSISTANCE QUESTIONNAIRE

Student Name                                                                                                                Social Security Number

INCOME, EXPENSES AND ASSET DATA
ALL APPLICANTS must complete the following financial information section. If the applicant is under 24 years of age and can still be
claimed by parent(s) for income tax purposes, parent(s) must complete the form as well.

                                                                                                                    STUDENT                   PARENT/SPOUSE               TOTAL
Adjusted Gross Income (from prior year’s tax return)                                                                $                         $                           $
Non-taxable Income (social security, child support, government assistance, etc.)                                    $                         $                           $
Federal Income Tax paid in prior year                                                                               $                         $                           $
Cash Savings, Checking Accounts, Investments                                                                        $                         $                           $
Home, if owned, assessed value                                                                                      $                         $                           $
Current mortgage balance                                                                                            $                         $                           $
Rent                                                                                                                $                         $                           $
Business/Farm Value                                                                                                 $                         $                           $
Business/Farm Debt                                                                                                  $                         $                           $

What are your sources of financial support for this applicant’s educational expenses:
Estimated Family Contribution $                               Federal and State Aid $        Other Scholarships/Loans $
Estimate yearly cost of college attendance:        Tuition $             Books/Supplies $   Room & Board $               Travel $
Are you eligible for the Tennessee HOPE Scholarship? Yes           No
Attach a copy of the page from your Student Aid Report that shows Expected Family Contribution (EFC) as a result of filing FAFSA.

Is this student currently employed?                 Yes          No           If yes, please complete the following information:
Employer
Address                                                                                              City                                                State          Zip
Date of Hire                                                                                                    Position
Supervisor                                                                                                       Phone

FAMILY INFORMATION
Name of father/stepfather/guardian or spouse                                                      Phone
Address                                                                  City                                    State        Zip
Employer                                                                      Occupation
Name of mother/stepmother/guardian or spouse                                                      Phone
Address                                                                  City                                    State        Zip
Employer                                                                      Occupation
Check if applicable:    Father Deceased     Mother Deceased   Parents Married    Parents Separated      Parents Divorced       Single Parent
Number of dependent children in the home           How many people in your household are attending college at this time, including applicant?
Did either parent graduate from college? No      Yes      Which one? Mother       Father

Part of the criteria is financial need. Describe personal or family circumstances that make it necessary for you to seek aid for your education. If you
and your family have unusual circumstances, such as illnesses not covered by insurance, unemployment, etc. that affect income, please include those
as well.




                                                                                CERTIFICATION
I/We certify that the information in this application is true and complete to the best of my knowledge. I/We understand that the financial information will be considered confidential for review
by the Board and Scholarship Committee of The Community Foundation of Middle Tennessee and any advisors it deems necessary pursuant to the Title V Gramm-Leach-Bliley Act. I/We
realize that this proof may include a copy of a U.S. tax return and/or state income tax return. I/We realize that failure to comply with a request for further information may prevent the applicant
from receiving any aid. I/We will supply any additional information The Community Foundation may request. Permission is hereby given to release financial information requested for
consideration with this scholarship application.

APPLICANT SIGNATURE                                                                                                                                         DATE

PARENT (SPOUSE) SIGNATURE                                                                                                                                   DATE




                                                                                                                                                                                                 5
                                         ACADEMIC APPLICANT APPRAISAL
Student Name                                                                                    Social Security Number

STUDENT INSTRUCTIONS: Have this section completed by a school administrator, counselor, dean, teacher or other person in a position
of authority who knows your academic accomplishments. Have him/her place the completed appraisal in a sealed envelope and sign the seal for
security. Enclose the unopened envelope in the completed application as you forward it to The Community Foundation. This form must be
completed by someone other than a family member.

APPRAISER’S INSTRUCTIONS: Please write whatever you think is important about this student, including a description of academic and
personal characteristics. We are particularly interested in the candidate’s intellectual promise, motivation, maturity, integrity, independence,
originality, initiative, leadership potential, capacity for growth, special talents, enthusiasm, concern for others, respect accorded by faculty and
reaction to setbacks. Also include how long you have known the student and in what context. We welcome information that will help us to
differentiate this student from others. You may attach a separate letter if you wish. Place the completed appraisal in a sealed envelope and
sign the seal for security. Return the sealed envelope to the student.




Ratings
Compared to others, how do you rate this student in terms of:
                                                                                     Good           Very Good                       One of the Top
                                                           Below                    Above           Well Above         Excellent   Few Encountered
 No basis                                                 Average     Average       Average          Average           Top 10%       in my career
               Academic achievement
               Extracurricular accomplishments
               Personal qualities and character
               Creativity, original thought
               Motivation
               Self-confidence
               Independence, initiative
               Intellectual ability
               Written expression of ideas
               Effective class discussion
               Disciplined work habits
               Potential for growth

I recommend this student:        With reservation         Fairly strongly         Strongly         Enthusiastically

Name                                                                            Title                                              Date
Organization
Address
City                                     State                         Zip                         Email
Signature                                                            Phone                                   Fax




                                                                                                                                                       6
                        EMPLOYMENT OR PERSONAL APPLICANT APPRAISAL
Student Name                                                                                        Social Security Number

STUDENT INSTRUCTIONS: Have this section completed by an employer, community/religious leader or other person in a position of
authority who knows you and your accomplishments. Have him/her place the completed appraisal in a sealed envelope and sign the seal for
security. Enclose the unopened envelope in the completed application as you forward it to The Community Foundation. This form must be
completed by someone other than a family member.

APPRAISER’S INSTRUCTIONS: Please write whatever you think is important about this student, including a description of personal
characteristics. We are particularly interested in the candidate’s intellectual promise, motivation, maturity, integrity, independence, originality,
initiative, leadership potential, capacity for growth, special talents, enthusiasm, respect and concern for others, and reaction to setbacks. Also include
how long you have known the student and in what context. We welcome information that will help us to differentiate this student from others. You
may attach a separate letter if you wish. Place the completed appraisal in a sealed envelope and sign the seal for security. Return the sealed
envelope to the student.




Ratings
Compared to others, how do you rate this student in terms of:
                                                                                           Good         Very Good                      One of the Top
                                                            Below                         Above         Well Above       Excellent    Few Encountered
  No basis                                                 Average      Average           Average        Average         Top 10%        in my career
               Leadership Potential
               Reaction to setbacks
               Integrity and character
               Creativity, original thought
               Motivation
               Self-confidence
               Independence, initiative
               Intellectual ability
               Written expression of ideas
               Effective class discussion
               Disciplined work habits
               Capacity for growth

I recommend this student:         With reservation         Fairly strongly          Strongly          Enthusiastically

Name                                                                              Title                                              Date
Organization
Address
City                                     State                         Zip                            Email
Signature                                                            Phone                                     Fax



                                                                                                                                                        7
                                      EMPLOYMENT VERIFICATION
                                               for the
                                     TURNER FAMILY SCHOLARSHIP
TO BE ELIGIBLE for the Turner Family Scholarship, you must be a current full-time or part-time employee of Dollar General.
Applicants must have no less than one year of service with Dollar General at the time of application.

To be completed by those applying for the Turner Family Scholarship. Please submit with completed application.

Individual employed by Dollar General:

Employee Name
                    last                                              first                                              mi

Social Security Number

Home Address

City                                          County                                                State          Zip

Home Phone (include area code)                                        Work Phone (include area code)

Store Number

Store Address

City                                          County                                                State          Zip

Job Title                                                                                           Date of Hire

Supervisor’s Name                                                                                         Phone




                                            The Community Foundation of Middle Tennessee
                                                       3833 Cleghorn Ave Suite 400
                                                        Nashville, TN 37215-2519
                                     (615) 321-4939 – (888) 540-5200 (toll-free) – (615) 327-2746 (fax)




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