AGS Scholarship Application
Abilene Geological Society Scholarship Applicant Information
Applicant’s High School ___________________________________________
Name : Last________________, First ________________________Middle ________________________
Home Address _____________________________________________________________
City _____________________ Zip Code __________________ Home Phone ________________
E-Mail Address: ______________________________________
Social Security Number x x x - x x - ________ (Provide the last four digits only until notification of award)
Date of Birth _____________________
Gender: Male or Female
Citizenship: U.S. Citizen Legal Resident Other
College you plan to attend Area of Study ___________________________________Have you been accepted?
Financial/Family Support Information
Father's Name: ____________________________________________
Father's Address (if different from above) __________________________________________
Father's Occupation __________________________
Mother's Name ____________________________________
Mother's Address (if different from above) __________________________________________
Mother's Occupation _________________________
Guardian name (if applicable) ____________________________________
Number of Children at home ________ Ages ___________ Number of Children presently in College ________ (fill out detail below) Child's Name
College Attending Full or Part Time?(If necessary, add additional page with more information about family members)
Please indicate your family's adjusted gross income from last year's tax return. Circle one:
0Under $25,000 0$25,000 to $40,000 0$40,000 to $60,000 0$60,000 to $90,000 0Over $90,000
Please be prepared to provide copies of pages 1 and 2 of your tax return if requested.
Please list all scholarships for which you have applied and note if you have received these awards as of the date you prepared this application.
Are you eligible to receive or have been offered a full-tuition scholarship based on merit, academics or sports?
If you will be receiving an athletic scholarship what percentage of college tuition, room and board will be covered by that scholarship? ______%
List approximate amount of college financial aid you will receive and sources (include any grants or awards not listed above, amount contributed annually by parents, amount to be contributed from student's savings and any college/university offerings):
How do you intend to finance remaining expense? (parent’s income, savings, loans, working)
Academic Achievements/Transcript Information
How many years at this school____ Rank in Class ______ Size of Graduating Class
Cumulative GPA________ SAT score ______ or ACT score _______
Extra Curricular Activities: By order of importance, list extra-curricular activities in which you participated while in high school. Please note any special honors received or offices held. Make a notation beside the ones you enjoyed the most and why. (Add page if more space is needed)
List areas of Community Service in which you have been involved; name the organization and what was accomplished while you were involved. Tell what it meant to you to participate in helping an organization or being involved with a particular group. (Add page if more space is needed)
List details concerning present or past employment. (Add page if more space is needed)
Certification: I understand that by signing this application, I am stating that all information is accurate to the best of my knowledge and I have not falsified or misrepresented any information contained in this application packet.
Please continue to the next page for additional requirements for this scholarship application. If you have any questions about the application packet to be submitted for a particular scholarship, please contact Nita Slaton, Scholarship Director, Community Foundation of Abilene, 325.676.3883, email@example.com.
The Community Foundation of Abilene mailing address is:
Community Foundation of Abilene
P. O. Box 1001 Abilene, TX 79604
Physical address is: Enterprise Building 500 Chestnut, Suite 1634 Abilene, TX 79602
Additional requirements for the Abilene Geological Society Scholarship:
Additional questions: Please list the approximate amount of tuition per semester of the college you wish to attend: $ ____________________. Name of College _______________________________
Essay Attach a 300 word essay as a separate page that explains Why you want to study geology, earth science, hydrology or environmental science.
Essay must be signed by applicant to indicate it is the applicant’s original work.
References Request one reference letter from either a member of the Abilene Geological Society or from one of your high school science teachers. This letter should be mailed to the below address by the person providing the reference information by April 1st. It is recommended that the applicant follow up on the requested references to assure they have been mailed in a timely manner.
Verify once more that your packet is complete prior to mailing it to the following address (or it may be hand-delivered if you prefer):
Mail to Community Foundation of Abilene
P. O. Box 1001 Abilene, Texas 79604
Or deliver to Community Foundation of Abilene 500 Chestnut, Suite 1634 Abilene, TX 79602
Deadline: April 1st