BROWNSTOWN CENTRAL HIGH SCHOOL SCHOLARSHIP APPLICATION FORM by aya20861

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									     The A. F. ROBERTSON FAMILY MEMORIAL SCHOLARSHIP APPLICATION FORM

         APPLICATION IS DUE IN COUNSELOR'S OFFICE BY MARCH 1
Date:

I.       PERSONAL INFORMATION
Name:
            (last)                             (first)                               (middle)

Home Address:                                                              Phone:

Date of Birth:                                           Place of Birth:

Residency: (circle)            Indiana YES NO             Jackson County    YES NO
                               Brownstown Township YES NO Hamilton Township YES NO

History of Residency:


Father’s Name:                                           Address:

Father’s Occupation:

Mother’s Name:                                           Address:

Mother’s Occupation:

Number and ages of brothers and sisters:


Marital status of applicant:                             If married spouse’s name:

Spouse’s Occupation:

Children:     Number                                                Ages

Military Service: Draft Status                            Have you been in the service? Yes     No

If so date of service:
II.      EDUCATION
Graduation or will graduate from                                               High school

Month                                  Day                                Year

List Extra Curricular Activities in whish you have participated in during you high school years.




What special recognition’s have you received (awards, offices, etc.)?




What college or school do you plan to attend?

What college of study do you plan to follow?



III.     OUT OF SCHOOL ACTIVITIES
List community, civic, and church activities in which you have participated.

List offices held, awards, etc.




IV.      EMPLOYMENT
List all part time or full time jobs held to date




Are you presently employed?                                  By Whom?
V.     FINANCIAL RESOURCES
PLEASE ATTACH A COPY OF THE FREE APPLICATION FOR FEDERAL
STUDENT AID FORM (FAFSA) OR A COPY OF THE FINANCIAL AID FORM
(FAF).
Approximate Sources of Financial Support

A.    From parent’s income or savings                 $
B.    From Student’s savings                          $
C.    From summer Employment                          $
D.    Awards or Scholarships                          $
E.    Other (list)                                    $



VI.      REFERENCES
Ask two adults to submit letters of recommendation to your guidance director. These letters will be added
to your application at the time the high school transcript and school appraisal is added.




VIII. AUTOBIOGRAPHICAL LETTER
Submit a letter of not less than 300 words in your own handwriting summarizing your activities,
accomplishments, objectives of further education and any other information that would indicate your
general worthiness and /or need for assistance. (Use additional paper as needed)

								
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