Helen Hodges Educational Charitable Trust Scholarship Application 2009-2010 Who May Apply • Undergraduates who have completed at least 60 semester hours toward a bachelor's degree Uunior standing) • Graduate students, including law students, medical students, etc. Please note: Students enrolled in programs that lead to the master's degree without first awarding a bachelor's degree (such as Physical Therapy) are considered undergraduates for these awards. • Students who are attending institutions in or who are from the South Plains area Anticipated Amount of the Awards: • $1000 for undergraduates • $1250 for graduates Basisfor the Awards: • Academic achievement • Financial need • Interview with the trustees • Statement of goals Important Dates: • July 15 Application materials due at American State Bank • Early-August Interviews • August 27 Scholarships awarded Instructions for Completing this Application • Please type or print this form clearly. Please include telephone, e-mail, and address information that will allow trustees to contact you in late July or early August. • Please attach a personal statement of no more than 250 words presenting your personal goals. Your statement may be typed, but please keep it to one side of one page. • Please attach transcripts showing your college work (photocopies are acceptable and may be unofficial copies from the school's website). Include transcripts from all colleges from which you received at least 12 credit hours or a degree. Transcripts will not be returned. • If you will enroll for the first time in graduate school during 2009-2010, attach a copy of your letter of acceptance • A complete application packet consists of the following documents: 1) The completed application form (you do not need to include this page) 2) The personal statement 3) Transcripts from all colleges from which you received at least 12 credit hours Send six collated & stapled copies of the complete application packet to the Trust Department, American State Bank, P.O. Box 1401, Lubbock, Texas 79401 by 3:00 pm on July 15~ 2009. You may hand-deliver the application to the bank's Trust Department on the 2 nd Floor of the American State Bank at 14th Street and Avenue Q in Lubbock. • If you have questions about this application or the Helen Hodges scholarships, please call Dr. Betsy Jones at (806) 797-6471 or (806) 743-1100 x233. Information is also available at www.ttuhsc.edufsom/fammed/hhect.aspx or e-mail at firstname.lastname@example.org 2 Helen Hodges Educational Charitable Trust Scholarship Application 2009·2010 Type ojApplication (check one) _ _ undergraduate _ _ graduate (Please note: Students enrolled in programs that lead to the master's degree without first awarding a bachelor's degree, such as Physical Therapy, are considered undergraduates for these awards.) Have you received a Helen Hodges Scholarship in the past? _ _ no _ _ yes If yes, year awarded _ PersonaUFinanciallnformation Name _ last first middle maiden (if applicable) Preferred Name _ Current Address _ City State Zip E-mail _ Home Phone Work or Cell Phone _ Please include telephone numbers that will allow us to contact you in late July or early August. Permanent Address (if different) Phone _ Birthdate Marital Status Number of Children _ Social Security Number _ Are you a U. S. Citizen? yes no If no, country of citizenship _ Are you currently employed? Yes, no, If yes, how many hours per week? _ Employer _ Monthly salary _ Do you plan to work during the 2009-2010 academic year? Yes No _ Please list the source and amount of funds you have available for 2009-2010 (indicate 0 if none from that source): Parents $ _ Scholarships $ _ Savings $ _ Loans $ _ Own Income $ _ Other $ (spouse, relative, etc.) Educationallnjormation Current Institution (2009-2010) _ Address _ Major/Type of Training Minor Degree Sought _ Grade Average (example: 2.8 on 4.0 scale) Number of semester hours to date _ Classification Expected graduation date Cost of Tui tion & Fees/semester _ Please list other colleges or universities you have attended and degrees awarded (use the back if necessary): school dates attended degree school dates attended degree school dates attended degree 3 Name and Location of High School Attended _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ year of Graduation _ What city to you consider to be your Hometown? _ Please I ist your major honors, awards, volunteer activ ities, professional organizations, or other activities. Please do not attach a resume or separate list. Family Information Parents' Names _ Address Number of Dependents _ Father's occupation Mother's occupation _ Is your father living? Is your mother living? Spouse's Name (if applicable) _ Address Number of Dependents _ Spouse's occupation Is your spouse living? _ Name and Address of Hometown Newspaper How do you plan to use the scholarship funds if awarded? signature date Your signature above indicates that the contents of this application packet are true and accurate. Please attach a personal statement of no more than 250 words presenting your personal goals. You may type your statement, but please keep it to one side of one page.
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