Helen Hodges Educational Charitable Trust Scholarship Application by kzv54984

VIEWS: 32 PAGES: 3

									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 betsy.jones@ttuhsc.edu
                                                                                                                                    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.


								
To top