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

 

Educational Plans

College you plan to attend Area of Study ___________________________________Have you been accepted?

Financial/Family Support Information

Father's Name: ____________________________________________

Phone:________________________

Father's Address (if different from above) __________________________________________

 

Father's Occupation __________________________

 

Employer______________________________________

 

Mother's Name ____________________________________

 

Phone:_______________________________________________

Mother's Address (if different from above) __________________________________________

Mother's Occupation _________________________

Employer ___________________________________

Guardian name (if applicable) ____________________________________

Number of Children at home ________ Ages ___________ Number of Children presently in College ________ (fill out detail below) Child's Name

Child's Age

College Attending Full or Part Time?(If necessary, add additional page with more information about family members)

 

INCOME

 

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

School Name___________________________________

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)

Employer

Dates of Employment

Approx. # of hours worked per week

Type of Work

______________________

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_______________________

______________________

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______________________

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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.

Name (printed)________________________________

Name (signed)_________________________________

Date _________________________________________

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, nslaton@cfabilene.org.

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