Academic Scholarship Application

Transcription

Jim Adams Chamber of Commerce Tinman Triathlon
Scholarship Application
Two scholarships approximately $1,000.00 each
CRITERIA: Awarded to one girl and one boy who are going onto college, has financial need and has high degree of
community service. Applicants are encouraged to volunteer for Tinman.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
COLLEGE YOU PLAN TO ATTEND: __________________________________
MAJOR:_____________________OCCUPATIONAL GOAL:________________
APPLICATION PROCESS:
1. Application
2. Essay about your vision for the future of Tupper Lake and how would you to see it
implemented in 1000 words or less.
Essay is to be typed, double spaced and 14 pt.
3. Transcript (unofficial copy)
4. Resume
5. Copy of financial aid packet from the college of your first choice.
Staple all of the above documents together in one packet in the order listed above.
Incomplete application packets will not be considered.
Adirondack Regional Federal Credit Union –
Donald DeVirgeles Memorial Scholarship Application
One, $750 award, two $150 awards, and three $250 awards
CRITERIA:
The competition will be open to students in all school districts in Franklin, Essex & Clinton Counties
and the underserved portion of St. Lawrence County. Applicants do not have to be a credit union
member to be eligible.
Eligible student must have a GPA of 80% or higher and attending a two or four year college with plans
to study in the business/math field.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
COLLEGE YOU PLAN TO ATTEND:__________________________________
1. Application
2. Short essay on why he/she is financially deserving of a scholarship.
Mail to:
Attn/ Scholarship Committee
Adirondack Regional FCU
280 Park Street
Tupper Lake, NY 12986
HEALTH CARE SCHOLARSHIP APPLICATION
The Adirondack Health Foundation’s mission is to support the efforts of
Adirondack Health in promoting health care in the community. As part of this
mission, the Foundation has created a Health Care Scholarship Program that
awards up to three scholarships annually for the payment of tuition for approved
area Nursing and Allied Healthcare educational and training programs. The
intent of this Scholarship Program is help to provide an educated and trained
health care workforce in the region at a time when there is a growing shortage of
health care workers.
HOW TO APPLY
This application must be submitted no later than Date Pending with the information requested below.
The application will not be reviewed unless all of the required information has been received.
Please answer each question as it is presented on the application. If a
question does not apply to you, mark your answer with n/a.
All applicants must submit the following:
1. A completed and signed Scholarship Application and Scholarship Agreement (see attached).
2. A copy of a Letter of Acceptance from an approved accredited program indicating you have been
accepted into a program leading to a degree in nursing or an approved allied health care profession.
3. A transcript of your high school grades showing all grades, including SAT & ACT scores, regents
grades, your class rank and cumulative average.
4. On a separate sheet of paper, write a personal statement of no more than one page detailing your
career aspirations, personal goals, leadership roles, activities or honors in high school and the community,
your financial need and other comments relevant to your application.
5. Please submit a Letter of Recommendation from a non-relative faculty member (for high school students)
or a non-relative supervisor (for non-traditional students).
The Letter of Recommendation must be
submitted with your application.
6. Page 1 & 2 of your most recent tax return (IRS Form 1040). If you are a dependent of your parents,
you must submit page 1 and 2 of their most recent tax return (IRS Form 1040).
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Submit this application to:
Scholarship Committee
Adirondack Health Foundation
P.O. Box 120
Saranac Lake, NY 12983
ELIGIBILITY
•
The Adirondack Health Foundation Scholarship Committee determines each award individually based
on the required information that is provided by the applicant during the application process.
•
Applicants must provide proof that they have been accepted into a course of study leading to a degree in
nursing or an approved allied health care career.
•
Applicants must be full time students taking a minimum of 12 credit hours per semester.
•
Applicants must live within the primary service area of Adirondack Health and/or have graduated
from one of the following high schools: Lake Placid, Saranac Lake, Tupper Lake, AuSable Valley,
Keene Central, Long Lake or St. Regis Falls.
•
Recipients must be in good standing and maintain a grade point average of 3.0 or higher while enrolled
in order to be considered for a second year scholarship and not be subject to repayment of scholarship
amounts previously awarded.
•
At the time of application, applicants must agree in writing to work for Adirondack Health for one (1)
year after graduation, if a position is available (as determined by Adirondack Health Human Resources
Department in consultation with the Foundation).
•
At the time of application, Applicants must agree in writing to repay any scholarship amounts awarded if
the applicant fails to meet the requirements of the program.
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PERSONAL PROFILE
Please Print or Type:
Name:
(First)
(M.I.)
(Last)
Home Address:
(Street Address including number)
City/Town
State
Zip
Mailing Address (if different)
Telephone (
Age
)
Email address: ___________________________________
Date of Birth
/
Do you reside with your parents or spouse?
/
Social Security #
Yes
No
(please circle which one)
Name of Parents/Spouse
Occupation of Parents/Spouse
List Other Family Dependents Along with Ages
Total adjusted gross income for the last calendar year according to IRS form 1040:
Parents’ / Household’s Gross Income:
Did you have income in the previous year? Yes
No
income did you earn? $
Where were you employed?
Present employment:
Year:
If so, how much employment
Full time
Part time
Do you have an immediate family member* who is currently, or has ever been, employed by
No
Adirondack Health or the Adirondack Health Foundation? Yes
If yes, please provide the person’s name, title and relationship to you:
* “Immediate family member” means your (1) husband or wife, (2) birth or adoptive parent, child or sibling, (3) stepparent,
stepchild, stepbrother or stepsister, (4) father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sisterin-law, (5) grandparent or grandchild, or (6) spouse of a grandparent or grandchild.
Do you have an immediate family member* who is currently, or ever was, on the medical staff of
Adirondack Health?
Yes
No
If yes, please the person’s name and relationship to you:
* “Immediate family member” means your (1) husband or wife, (2) birth or adoptive parent, child or sibling, (3) stepparent,
stepchild, stepbrother or stepsister, (4) father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sisterin-law, (5) grandparent or grandchild, or (6) spouse of a grandparent or grandchild.
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What accredited college will you be attending?
What course of study do you intend to follow?
Are you a U.S. Citizen?
If no, please explain:
Have you ever been convicted of committing a felony offense involving marijuana, controlled
No
Yes
substances or dangerous drugs or an assault, physical injury or death?
If yes, please explain:
Are you in default or do you owe a refund on any educational loan?
If yes, please explain:
No
Yes
RECOMMENDATIONS
Please submit a letter of recommendation from a non-relative—for high school students, a faculty member;
for non-traditional students, your immediate supervisor.
ACADEMIC PROFILE
Name of High School Attended:
Address:
For High School Students:
Expected Date of Graduation:
Please attach a copy of your high school transcript
showing SAT & ACT scores, regents grades, your class rank and cumulative average.
For Non-Traditional Students:
Year of High School Graduation:
Other institutions previously attended and hours earned (if any):
Date of Entrance:
In what educational program were you enrolled?
Associates
Bachelors
Masters
In what major?
Please attach a transcript of your grades.
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FINANCIAL INFORMATION
Please note: Each line of the financial information section of the application must be completed.
If you are not receiving aid or income in the categories listed below,
please mark that line with “n/a” as not applicable.
Academic Program Costs and Support
What is the estimated annual cost at the college you expect to attend?
Tuition:
Room:
Board:
$
$
$
Books:
$
Incidentals:
$
TOTAL COSTS:
$
Please indicate the level of support you will be or are currently receiving from the programs listed below on an
annual basis. Indicate the amount for each (estimate aid if you don’t have exact figures).
Pell Grant
Scholarship
Work Study
Student Loans
$
$
$
$
Voc Rehab
$
V.A. Benefits
$
Other
$
TOTAL SUPPORT:
$
Income
Please indicate the annual income you anticipate upon college entrance from the sources listed below. Indicate
the amount for each.
Parental Support
Employment
Child Support
Alimony
Social Services
$
$
$
$
$
Unemployment
Social Security
Worker’s Comp
Other
TOTAL INCOME:
$
$
$
$
$
Verify your adjusted gross income:
You must include a copy of Page 1 & 2 of your recent tax return – IRS Form 1040.
If you are a dependent of your parents,
you must include page 1 & 2 of your parents most recent IRS 1040.
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AGREEMENT
I certify that the information I have provided in this application is true and accurate. I will notify the
Foundation if any of this information changes.
I understand and agree that the purpose of the Scholarship Program is to defray the cost of tuition and any
scholarship awards will be made payable each semester to the school that I am attending, so long as I have met
all of the Scholarship Program requirements.
I understand and agree that I am obligated to repay the full amount of any scholarship awarded, if I change my
course of study to something other than a nursing or allied health care field, as the case may be, or fail to meet
the requirements of the Scholarship Program, as described in the Health Care Scholarship Program Agreement.
I understand and agree that the scholarships offered by the Adirondack Health Foundation are dependent
upon the availability of Foundation funding and cannot be guaranteed.
I understand and agree that I am obligated to notify the Foundation if my student status changes from that
which is indicated in this application.
I hereby give permission to use any general, non-financial information included with this application for
publicity purposes; to provide the Foundation with photographs of myself and give permission for the usage
of such photographs; and to participate in scholarship recognition ceremonies of the Foundation’s choosing.
I hereby authorize the release of this application and any relevant supporting information to person involved in
the selection process and awarding of scholarship recipients.
Applicant’s Signature
Date
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ADIRONDACK HEALTH FOUNDATION
HEALTH CARE SCHOLARSHIP PROGRAM AGREEMENT AND PROMISSORY NOTE
I,
, by applying for the Health Care Scholarship
Program offered by the Adirondack Health Foundation, do hereby agree as follows.
Scholarship Recipient Responsibilities
If I am awarded a Health Care Scholarship, I agree that I shall:
•
Maintain satisfactory progress in a course of study leading to a degree in nursing or an allied health
care field of study.
Satisfactory progress means being in good standing and maintaining a
grade point average of 3.0 or higher for each quarter or semester of the two-year program.
•
Submit a grade report for each quarter or semester along with a course schedule for the
upcoming semester or quarter immediately after the completion of each semester or quarter. I
understand that further scholarship funds may not be awarded if I have not maintained satisfactory
progress in my course of study.
•
Keep the Adirondack Health Foundation apprised of any change in my academic status while receiving
scholarship assistance.
•
During my final semester, verify with the Foundation that I have consulted with the
Adirondack Health Human Resources Office regarding possibilities for employment. Such consultation
in no way assures employment with Adirondack Health.
•
Upon sixty (60) days of graduation, work at Adirondack Health for a period of one (1) year in a position
that requires the degree awarded during my course of study, assuming a position is available as
determined by Adirondack Health in its sole discretion.
Repayment Requirements
1.
I understand and agree that I shall be required to repay any scholarship amounts awarded if
the following occurs:
• I fail to maintain satisfactory progress, as defined above, in a course of study leading to a degree in
nursing or an allied health care field of study for each quarter or semester that I am enrolled in the
program.
• I fail to complete the program within two (2) years.
• I fail to accept employment at Adirondack Health if a position is available within sixty (60)
days of graduation.
• If such employment is offered and accepted, I fail to continuously work for Adirondack
Health for a period of one (1) year.
• I fail to meet any other requirements of the program.
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2.
If any of the events specified in Repayment Requirements, Section 1 occur, I hereby promise and
agree to pay to the order of the Adirondack Health Foundation the total amount of scholarship funds
awarded, with interest compounded at the current Wall Street Journal prime rate as published in the Wall
Street Journal, in regular monthly payments within a period not to exceed twenty-four (24) months.
3.
Adirondack Health reserves the right to waive the interest payment if extenuating
circumstances exist.
4.
I understand that that I may prepay this note wholly or in part at any time without penalty.
5.
In the event that I return to employment at Adirondack Health within twelve (12) months of graduation
and fulfill the remainder of the work time required under the terms of the program, the Adirondack Health
Foundation may decide, in its sole discretion, to forgive the remaining principal and interest due and payable.
6.
If employment is not available at Adirondack Health within my field of study within sixty (60)
days of graduation, I understand that I am not obligated to repay any scholarship funds awarded.
Default and Acceleration
1.
I understand and agree that if I default on the payment of the principal and interest, the entire unpaid
balance of this note shall become immediately due and payable with attorney fees and costs of collection.
2.
I understand and agree that in lieu of accelerating this note, Adirondack Health Foundation may at its
option impose a fine of ten percent (10%) of the amount of any delinquent installment hereunder.
Miscellaneous
1.
I understand and agree that the scholarships offered by the Adirondack Health Foundation are dependent
upon the availability of Foundation funding and cannot be guaranteed.
2.
I understand and agree that such scholarships may be considered taxable by the Internal Revenue
Service and that I am responsible for any tax liability incurred as a result of this award. The Adirondack Health
Foundation will provide no tax information to me or to the Internal Revenue Service.
I hereby consent and agree to the foregoing.
Student Signature
Date
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-------------------------------------------------For Office Use Only-----------------------------------------------------Application received completed with all attachments.
Date:
Date application approved:
Award amount $
Signature:
Date:
Adirondack Health Foundation Executive Director
/CBR
10/07; updated 02/12
C:\Scholarship\Application
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Rose Beausoleil Memorial Scholarship Application
Five awards/Approximately $500.00/One time award
CRITERIA: A graduating Senior going onto a 2 or 4 year college that demonstrates financial need
and has the ability to complete their intended course of study successfully.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Brief essay about yourself and what your future plans are
4. Resume
5. Copy of financial aid packet from the college of your first choice
Edna Bellows Memorial Nursing Scholarship Application
Approximately $150.00/One time award
CRITERIA: Awarded to a senior who has been accepted to an accredited school of nursing or a
school of medicine and/or medical technology. Must demonstrate motivation and financial need.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Brief essay about yourself and what your future plans are.
4. Resume
Harry Bellows Memorial Technical Scholarship Application
CRITERIA: Graduating senior who will be continuing their education in the field of automotive
technology or other technical field.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
4. Resume
Big Wolf Lake Association Scholarship Application
Approximately $1,000.00/One time award
CRITERIA:
Demonstrated a concern for the environment or general sciences
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Brief essay about your concern for the environment and/or general science, yourself and what you are future plans.
4. Resume
Avis C. Bill Memorial Scholarship Application
CRITERIA:
Senior going onto college who has demonstrated the potential for academic achievement and community
service.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Personal essay, which describes your plans for higher education, what you feel is your
academic potential, and your participation in community service projects.
4. Resume
Bionique Testing Laboratories Inc.
ACADEMIC YEAR 2014 – 2015
Awarded to a student who will be entering a college program leading to a career in the sciences.
1. Name: _____________________________________________________________________
2. Address:___________________________________________________________________
___________________________________________________________________________
3.
Name of School you are currently attending:
________________________________________________________________________
4. Name of College/University you will be attending: (Please list full name and address)
___________________________________________________________________________
5. When were you accepted:
______________________________________________________
6. What course of study do you intend to follow? _____________________________________
7. Scholarship: High School Grade Average_________________________________________
Current Curriculum_________________________________Regents ____Yes ____No
8. Citizenship: School Activities and community involvement.
a. State your school related extracurricular activities, including sports, music, drama, etc.
Indicate the length of time you have been involved and the level of your involvement
organizer, etc.):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
b. Honors and awards: _______________________________________________________
___________________________________________________________________________
(member, officer,
___________________________________________________________________________
___________________________________________________________________________
c. Out-of-school activities, including employment, hobbies and service to community,
church and
family. Indicate the length of time you have been involved and any notable
accomplishments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
9. Include a Letter of Recommendation from one of your science teachers.
10. Please state why you want to major in the biological sciences & what your future plans are:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Charles Blackman Give Back Scholarship Application
Approximately $1,000.00
CRITERIA:
A student going onto college who has worked hard and has been a good person
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Brief essay about how you will give back to the community whenever possible
4. Resume
Floyd & Ruth Carmichael Memorial Nursing Scholarship Application
Approximately $100.00
CRITERIA: Student accepted to North Country Community College following a nursing program. If
none, any nursing program, any college.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
4. Resume
Cheverette-Goff Scholarship Application
CRITERIA: Senior going on to a 4 year college, graduating from High School in good standing.
Must possess good community involvement and have participated in extra curricular school
activities and must demonstrate financial need.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Brief essay about school and community activities, yourself and what your future plans are.
4. Resume
Benjamin Churco Post 220
Tupper Lake American Legion Scholarship Application
CRITERIA: A Senior going on to an accredited college or university who possesses a commitment
to scholastic excellence and community service.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Prepare a three page essay (typed, double spaced, 14 point) describing your
views on duties of citizenship. Describe some of your personal examples.
4. Resume
Harriet L. Cohn Memorial Scholarship Application
CRITERIA:
Student attending a four year college majoring in math, science, nursing, teaching,
business or medicine. Financial need, scholastic & community performance is to be of
paramount importance.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
4. Resume
Babe Duane-Ruth Collins Memorial Nursing
CRITERIA:
A student demonstrating financial need and going into the nursing or medical
profession.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Brief essay about yourself and why you have chosen the medical field.
14 pt.
4. Resume
Essay is to be typed, double spaced and
Mary Cote Humanitarian Scholarship Application
Criteria:
A senior going on to a higher education program pursuing a career in the Human services field (i.e.
social work, occupational therapy, etc.) Medical field or education. A middle class family who
demonstrates financial need but is not necessarily eligible for conventional assistance.
Your completed application MUST include:
1. Application
2. Transcript
3. Resume
4. Personal Essay
5. Most recent financial aid package
6. Name and address of college you will attend in 2014– 2015
The grant is only awarded for one year.
Mary Cote Humanitarian Scholarship Application
Please type or print in black ink.
SECTION 1- GENERAL INFORMATION:
1. Name (Mr./Miss) ___________________________________________________________________________
2. Address: __________________________________________________________________________________
Street Address
City
Zip Code
3. Telephone Number _________________________________________________________________________
4. Age:_______
Date of Birth:______________________
5. Name of Parents/Guardians____________________________________________________________________
6. What accredited college or trade or technical school will you be attending? (Please give full name and full address).
__________________________________________________________________________________________
__________________________________________________________________________________________
7. What course of study do you intend to follow?
__________________________________________________________________________________________
EDUCATIONAL RECORD:
8.
What was your CR SAT score __________and your Math SAT score __________
9. What type of degree are you working toward?
___________________________________________________________________________________________
RESUME:
10.
Please submit a resume which includes educational awards/honors, extracurricular activities, offices held in school organizations, and
work experience.
PERSONAL ESSAY:
11.
On a separate paper, submit a personal essay which describes your plans for higher education, what you feel is your academic
potential, and your participation in community service projects.
DATED:______________________ SIGNATURE:___________________________________________________
Crary Education
Scholarship Fund
One time award / Approximately 5 awards, $500.00 each
CRITERIA: The student must be a Franklin, Essex, Hamilton or Warren County resident demonstrating financial
need. Gross family income not to exceed $80,000.00 or needs to demonstrate an unusual financial need.
Go to www.craryfoundation.org to explore our website and start the application process.
Click on Scholarship Application Portal on the Home Page.
This will take you to the logon page of the Bruce L. Crary Foundation / Foundant Technologies
Grant Management Software where you will create your account.
Enter your email address and a password.
Fill out the registration form. All questions marked with * must be answered.
Click on Next Step
You will be asked to enter and confirm your password.
Click on Finish
You will be asked to verify that our system sent an email to you. If it does not appear in your inbox,
check your junk or spam folder, and be sure to allow emails from Crary Foundation.
Click on Continue
Click on 2015-16 Crary Scholarship Application
You will see your contact information (your Profile) at the top of the form. To edit that information
click on the yellow “pencil” icon in the right margin.
Complete the application to the best of your ability. You may save information in your application
and return to it at any time until it is submitted. If you don’t have all your financial information,
please provide us with an estimate.
Click on Submit when you have completed your application. No changes can be made after the
application has been submitted. If you need to make a correction, contact us.
Click on Continue
From your Application Status Page, you can review your application, and starting in July you can
view the status of your application.
2015-16 Crary Scholarship Application Instructions
Go to www.craryfoundation.org to explore our website and start the application process.
Click on Scholarship Application Portal on the Home Page.
This will take you to the logon page of the Bruce L. Crary Foundation / Foundant Technologies
Grant Management Software where you will create your account.
Enter your email address and a password.
Fill out the registration form. All questions marked with * must be answered.
Click on Next Step
You will be asked to enter and confirm your password.
Click on Finish
You will be asked to verify that our system sent an email to you. If it does not appear in your inbox,
check your junk or spam folder, and be sure to allow emails from Crary Foundation.
Click on Continue
Click on 2015-16 Crary Scholarship Application
You will see your contact information (your Profile) at the top of the form. To edit that information
click on the yellow “pencil” icon in the right margin.
Complete the application to the best of your ability. You may save information in your application
and return to it at any time until it is submitted. If you don’t have all your financial information,
please provide us with an estimate.
Click on Submit when you have completed your application. No changes can be made after the
application has been submitted. If you need to make a correction, contact us.
Click on Continue
From your Application Status Page, you can review your application, and starting in July you can
view the status of your application.
Your school’s application deadline is: ______________________________
Remember to update your Profile page if any of your contact information changes.
If you have any questions or need help with the application, contact your School Counselor.
Best wishes in your studies!
Crary Education Fund
P.O. Box 396 Elizabethtown, NY 12932
518-873-6496
director@craryfoundation.org
www.craryfoundation.org
Erin Farkas Dewyea
Memorial Scholarship
Approximately $1500
CRITERIA: Senior going onto college, to pursue a degree in education, (preferably elementary
education). Involvement in extracurricular activities (athletic, drama, band, chorus etc.) and
community service.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. One letter of Recommendation
3. A brief essay on how you have improved your community through community service or
volunteering. Essay is to be typed, double spaced and 14 pt. font, 500 words or less.
5. Resume
Tami E. Dumas Memorial Scholarship Application
CRITERIA: A student who has participated in athletics and has a scholastic average that reflects
that they are working up to his or her potential and will be attending a two or four year college
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
4. Resume
Irene B. Fee Memorial Scholarship Application
CRITERIA: A senior going on to pursue a teaching degree. Preferably Social Studies, French or
Spanish
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Brief essay about yourself, what your future plans are and why you have decided to be
teacher.
4. Resume
Hugh Felio Memorial Scholarship Application
CRITERIA:
A senior who will pursue a college program in business. Demonstrated an outstanding
work ethic. Student's performance indicates that he/she will finish college. Student
loves to ski.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Brief essay about yourself, finishing a college program, skiing and what your future plans
are.
4. Resume
John R. Fletcher Memorial Scholarship Application
CRITERIA: Good student going on to pursue higher education. Participation in school/community
activities as well as high scholastic performance.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Brief essay about yourself, participation in school/community activities and what your future
plans are.
4. Resume
Franklin County School Service Association Scholarship Application
CRITERIA:
For graduating senior who is furthering their education in the areas of food service or nutrition.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application Page 1 & Page 2
2. Staple Page 1 & Page 2 together
Mose H. & May Ginsberg Memorial Scholarship Application
Approximately $500.00 each for one male and one female/One time award
CRITERIA:
Best female and male athlete going onto college.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
4. Resume
CSEA/Arthur Graham Scholarship Application
Ten scholarships
CRITERIA:
Available to students whose parents are members of the Sunmount Chapter of the
CSEA Union. Student who demonstrates financial need, perseverance and ability to
complete his/her education.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Letter indicating the course of study you plan to pursue, what college you will attend, and
family situation (example: Name of parents, how many children, and why you believe you
should receive this scholarship).
2. Transcript
3. Application
Grulich Memorial Scholarship Application
Approximately two awards of $350.00 each
CRITERIA: TLHS graduate with a scholastic average reflecting his/her potential, has been an active
participant in school and community activities and is pursuing a four year college
degree.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Essay describing a meaningful high school experience that took place either in or outside of
school
3. Essay is to be typed, double spaced and 14 pt.
5. Resume
6. Two letters of recommendation
7. Copy of financial aid packet from the college of your first choice
Laurie Hart Gushea & Debbie Young Memorial Scholarship Application
CRITERIA:
Graduating senior going into the medical field.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Brief essay about yourself, why your chose the medical field and what your future plans are.
4. Resume
Infant Jesus of Prague, Inc. Academic Scholarship Application
$2,000.00 ($500.00 paid at the beginning of each academic year for 4 years)
CRITERIA:
For a student attending a 4 year college who graduates in the top 25% of the class
(preferred but not necessary). Renewable for 3 years.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
3. Letter of reference from a teacher.
4. Transcript
5. Resume
Infant Jesus of Prague, Inc. Technical Scholarship Application
($500.00 at the beginning of the 1st and 2nd years of technical school)
CRITERIA: Accepted to a technical school. Renewable for one year.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
3. Letter of reference from a teacher AND an employer
4. Transcript
5. Resume
Knights of Columbus Scholarship Application
CRITERIA: The student must be accepted to an accredited institution beyond high school. Student
demonstrates financial need, perseverance and ability to complete his/her education.
Priority consideration is given to the children, grandchildren, etc. of Knights of
Columbus members.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Cover letter stating full name, father’s name and occupation, institution you plan to attend,
courses to be studied and reasons why you wish to apply for this scholarship.
Letter is to be typed, double spaced and 14 pt.
4. Resume
lakeplacid sinfonietta
THE ORCHESTRA OF THE ADIRONDACKS
Lake Placid Sinfonietta Annual Merit Award
Please send hard copies of application (no electronic files please) of completed application packages to:
Lake Placid Sinfonietta
PO Box 1303
Lake Placid, NY 12946
Applications must be postmarked or received by the Lake Placid Sinfonietta by Date Pending
This Award is a one-time award to a graduating senior of up to $500. If you have questions, please call or email me or
contact Kathy Briggs, the Lake Placid Sinfonietta's Board of Directors' Education Committee Chairperson.
It is not necessary to use this form if the requested information is provided in the manner described in the application.
Deborah Fitts, Executive Director
Tel:518.523.2051
Email:info@LakePiacidSinfonietta.org
Website: www.LakePiacidSinfonietta.org
The mission of the Lake Placid Sinfonietta is to be a cornerstone of life in the Adirondacks
through live performances of accessible, educational, and exceptional music.
,.
LAKE PLACID SINFONIETTA MERIT AWARD APPLICATION FOR
OUTSTANDING ACHIEVEMENT AND POTENTIAL IN MUSIC
Applicant must:
1.
Be a graduating senior of Lake Placid High School, Saranac Lake High School, Tupper Lake High School, or Keene Valley
High School.
2. Intend to pursue a course of study in a post-secondary educational program.
3. Show intent to include music as a part of her/his future.
4.
Complete this application form and submit it along with a resume, a copy of his/her high school transcript, and two letters of
recommendation. The letters of recommendation should include information on musical involvement and strength of
character.
5. Forward the completed application and letters of recommendation to the
Lake Placid Sinfonietta through the applicant's high school guidance office.
Please complete the following by printing or attaching a typed document with the requested Information.
1. Personal Information
1.
Name_______________________________________________ Date of Birth_____________________________
2.
Anticipated Graduation Date____________________________
3.
Address ______________________________________________________________________________________
4.
Telephone Number________________________
5.
Parent/Guardian Name(s) and address (if different from your own)_______________________________________
Email Address_________________________________________
_____________________________________________________________________________________________
2.
3.
College Information
1.
College planning to attend? _______________________________________(If not certain, please explain in essay)
2.
Anticipated Major________________________________________ Anticipated Minor_______________________
3.
Anticipated Degree_____________________________________________________________________________
Connecting with the Lake Placid Sinfonietta
1.
How did you become aware of this award? _________________________________________________________
2.
3.
Have you ever attended a Lake Placid Sinfonietta Concert? ____________________________________________
If you are selected to receive this award, will you be available on August 11, 2013 to take part in lighting candles during the Lake
Placid Sinfonietta's concert at the Lake Placid Center for the Arts? Yes/No
(Availability on this date will not affect consideration of your application)
4. Essay
On One Side of a separate piece of paper please describe:
1) how music has been a part of your life ,and
2) how you plan to make music a part of your future.
This merit award will be granted on the strength of the application as
reviewed by representatives of the Lake Placid Sinfonletto.
Jason Larabie Memorial Scholarship Application
CRITERIA: Graduating senior going on to college; possesses a strong community service
background; respectful and loyal to school/community; knows the value of hard work and study.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Brief essay on the respect and honor to Military Members.
3. Letter of Recommendation (Teacher/Counselor)
4. Provide evidence of community support
6. Resume
7. Letter of Acceptance from an accredited college
Leonard & Charlotte Larocque Scholarship Application
Two awards approximately $500.00 each/One time award
CRITERIA:
Awarded to a student who will be pursuing a teaching career or business career
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
4. Resume
Joseph "P-2" LeBlanc Memorial Scholarship Application
$500.00 first semester and $500.00 for the second semester
CRITERIA:
Student going onto a two year college majoring in business.
Joseph "P-2" LeBlanc SCHOLARSHIP
Tupper Lake Central School District
TupperLake, NY 12986
1.
2.
3.
4.
5.
Transcript
Resume
Personal Essay
Most recent financial aid package
Name & address of college you will attend in 2014 – 2015.
1. Name(Mr./Miss)________________________________________________________________________________
2. Address_______________________________________________________________________________________
Street Address
City
Zip Code
3. Telephone Number______________________________________________________________________________
4. Age_____ Email_____________________________________ Date of Birth______________________
5. Name of Parents/Guardians___________________________________________
6. Have any siblings attended college before you?___________ Are you an only child? _______________
7. What accredited college or 2 year school will you plan on attending? (Please give full name and full address).
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
EDUCATIONAL RECORD:
8. What was your CR SAT score_____ and your Math SAT score_______________________________
_____________________________________________________________________________________________
RESUME:
10. Please submit a resume which includes educational awards/honors, extracurricular activities, offices held in
school organizations, and work experience.
PERSONAL ESSAY:
11. On a separate paper, submit a personal essay which describes how you have made a difference in during your
high school years and where you would like to make a difference in the future. Also describe your plans for higher
education; what you feel is your academic potential, and your participation in community service projects.
DATED:_____________________ PRINTED NAME:______________________________________________
SIGNATURE:__________________________________________________
Note: A Grant is awarded for $500 for each semester for one year only.
Upon completion of first semester, please send a letter describing your first semester of college including:
•
•
•
Your most memorable experience - what you are most proud of
Your most challenging experience
Your advice to a new student
Julia Hershman Maroun Memorial Scholarship Application
CRITERIA: A graduating senior who is an outstanding English student who will be attending a two
or four year college.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
4. Resume
ALBERTA P. MOODY HIGHER EDUCATION SCHOLARSHIP
Tupper Lake Central School District
Tupper Lake, NY 12986
1. Transcript
2. Resume
3. Personal Essay
5. Name & address of college you will attend in 2014-2015
SECTION 1 – GENERAL INFORMATION:
1. Name (Mr./Miss) ______________________________________________________________________
2. Address _____________________________________________________________________________
Street Address
City
Zip Code
3. Telephone Number ____________________________________________________________________
4. Age ________ Date of Birth ______________________ Soc. Sec. # ___________________________
5. Name of Parents/Guardians _____________________________________________________________
6.
What accredited college or trade or technical school will you be attending? (Please give full name and full
address).
____________________________________________________________________________________
____________________________________________________________________________________
7.
What course of study do you intend to follow?
____________________________________________________________________________________
EDUCATIONAL RECORD:
8.
What was your CR SAT score ________________ and your Math SAT score ___________________
9.
What type of degree are you working toward?
___________________________________________________________________________________
RESUME:
10.
Please submit a resume which includes educational awards/honors, extracurricular activities, offices held in
school organizations, and work experience.
PERSONAL ESSAY:
11.
On a separate paper, submit a personal essay which describes your plans for higher education, what you feel is
your academic potential, and your participation in community service projects.
DATED: ________________________ SIGNATURE: _______________________________________________
Note: A Grant is awarded for one year only.
Alberta Moody Memorial Scholarship Application
CRITERIA: Follow a four year course of higher education majoring in the fields of mathematics,
science, engineering or medicine. Financial need, in addition to high scholastic
performance.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
4. Resume
Moose #640 Scholarship Application
CRITERIA:
Accepted to two or four year college
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
4. Resume
Moose #640 Scholarship Application
CRITERIA:
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
4. Resume
Mt. Arab Lodge #847 Masonic Scholarship Application
Approximately one award of $500.00 /One time award
CRITERIA: Demonstrates financial need, acceptance to an accredited college, liberal arts/business,
4 year degree. Ability to complete intended course of study. Motivated to succeed in course
of study or degree program.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
3. Essay is to be typed, double spaced and 14 pt.
5. Resume
Pearle Ness Clements Scholarship Application
Criteria:
Graduating Senior going onto college who demonstrates financial need, attending a four year
college, or trade school, entering the fields of science, math and engineering (one award / renewable
for three)
1. Application
2. Transcript
3. Resume
4. Personal Essay
6. Name and address of college you will attend
The grant is only awarded for one year.
PEARLE NESS CLEMENTS SCHOLARSHIP
1. Name (Mr./Miss) ___________________________________________________________________________
2. Address: __________________________________________________________________________________
Street Address
City
Zip Code
3. Telephone Number _________________________________________________________________________
4. Age:_______
Date of Birth:______________________
5. Name of Parents/Guardians____________________________________________________________________
6. What accredited college or trade or technical school will you be attending? (Please give full name and full address).
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
EDUCATIONAL RECORD:
8.
What was your CR SAT score __________and your Math SAT score __________
___________________________________________________________________________________________
RESUME:
10.
Please submit a resume which includes educational awards/honors, extracurricular activities, offices held in school organizations, and
work experience.
PERSONAL ESSAY:
11.
On a separate paper, submit a personal essay which describes your plans for higher education, what you feel is your academic
potential, and your participation in community service projects.
DATED:______________________ SIGNATURE:___________________________________________________
NORTHERN ZONE ASSOCIATION FOR
COUNSELORS AND DEVELOPMENT
SCHOLARSHIP APPLICATION
Criteria: Awarded to 2 seniors in the Northern Zone who plan to enter a counseling field.
The NYSUT Retiree Scholarship Application
Criteria: Awarded to a senior from Franklin or St. Lawrence County who plans to enter the
education field.
Four $200 scholarships will be awarded by the Northern Zone of the New York State Retired Teachers’ Association—
Two to St. Lawrence County students and two to Franklin County students.
Who:
Any high school senior pursuing a career in teaching profession is eligible.
When: You must submit your completed application by April 1, 2015 It must be received by and not postmarked by
the above date.
To
Mrs. Gayla LePage
189 County Route 16
North Bangor, NY 12966
John H. Pape Memorial Scholarship Application
Approximately two award $450.00each/One time award
CRITERIA: Good citizen, with a desire to succeed, must be an average to above average student
with emphasis on goals in a vocational or technical field.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
4. Resume
James Person Memorial Award
Approximately $1000 One time award
CRITERIA: A graduating senior who shows leadership, honor and respect for family, friends and community; shows
pride in being a Lumberjack who has participated in sports and loves the outdoors; willingness to help others,
average to above average grades.
NAME:______________________________________________________________________________________
ADDRESS:___________________________________________________________________________________
FUTURE PLANS:______________________________________________________________________________
MAJOR:(if applicable)___________________________________OCCUPATIONAL GOAL:________________
1. Application
2. In a brief essay describe why you believe you fit the criteria for this award, your future plans & how this award will
help you attain your goals.
4. Resume
Samantha J. Pickering
Memorial Scholarship
Approximately $500
CRITERIA: This Scholarship is for a graduating Senior going onto a two or four year college
and continuing to play their sport at the Varsity collegiate level. This student must possess a
strong dedication and allegiance to their family, their school, their community and their sport.
They are a friend to all staff and students alike and shows no bias or ill feelings toward any
person.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Two letters of Recommendation (1 from an academic perspective and 1 from an athletic
perspective)
3. A brief essay describing your academic success, school attendance record and your athletic
participation. Essay is to be typed, double spaced and 14 pt. font, 500 words or less.
5. Resume
Patrick E. and Louise M. Quinn Memorial Scholarship Application
Two awards / Approximately $500.00 each
Scholarship will be awarded to student(s) at the beginning of their second year of college
CRITERIA: Student intending to pursue a degree in the science field and/or a student planning to study in the
fields of physical, occupational or rehabilitative therapy.
Demonstrates exemplary community service within the school and/or community.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Personal essay to include your involvement in community service within the school and/or
community.
4. Resume
Rotary Memory Tree Scholarship Application
CRITERIA: A student pursuing a 2 or 4 year colleg degree in a business related field in college.
Applicant should display high integrity, character and a commitment to public service.
Relatives of Rotarians will be given special consideration.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application.
2. Cover letter stating what school you plan to attend, career plans and/or aspirations and what
community service you have done.
4. Resume
Rotary Club International of Tupper Lake Scholarship Application
CRITERIA: Student pursuing a 2 or 4 year college degree. Student must be in good scholastic
standing & has completed community service. Relatives of Rotarians will be given
special consideration.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application.
2. Cover letter stating what school you plan to attend, career plans and/or aspirations and what community service you
have done. Essay is to be typed, double spaced and 14 pt.
4. Resume
Dennis R. Rule Memorial Scholarship Application
CRITERIA: Student pursuing a higher education in the healthcare field. Must demonstrate financial
need and scholastic achievement is the primary importance.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
1. Brief essay about yourself and why you are interested in a career in health care. Essay is to be typed, double spaced
and 14 pt.
3. Two letters of recommendation.
4. Resume
Nellie Staves Memorial / Rod and Gun Club Scholarship Application
CRITERIA: Student must demonstrate financial need, curriculum related to Environmental Science,
must be motivated and have the ability to complete the intended course of study or
degree program
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. A 500 word essay on Conservation, what it means to you, and what you would like to accomplish.
The essay must be typed, double spaced and 14 pt. font.
3. Transcript
4. Resume
Patrick Tice Memorial Scholarship Application
CRITERIA:
Student is an athlete who has demonstrated the willingness to succeed on a competitive basis and who
will be going onto college.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
4. Resume
Tupper Lake United Teachers Rena Proulx Farmer Scholarship
Application
The awards are given in two installments of $750.00 each at the beginning of the first two semesters of college study.
CRITERIA: Student demonstrates financial need and promise for success in college.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Submit a letter of application which discusses the college you will be attending,
the degree sought and the your occupational aspirations.
4. Resume
6. Two letters of recommendation from persons other than teachers or administrators.
Tupper LakeUnited Teachers L.P. Quinn Memorial Scholarship
Application
The awards are given in two installments of $750.00 each at the beginning of the first two semesters of college study.
CRITERIA: Student demonstrates financial need and promise for success in college.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Submit a letter of application which discusses the college you will be attending,
the degree sought and the your occupational aspirations.
4. Resume
6. Two letters of recommendation from persons other than teachers or administrators.
Tupper Lake High School Student Council Scholarship Application
CRITERIA: Well rounded student, participation in various sports, drama, music groups,
government, community service or church groups. More than one of these categories
must be fulfilled throughout high school career.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Cover letter about yourself, what your future plans are, a complete list of activities and the number of years
participated.
Letter is to be typed, double spaced and 14 pt.
3. Two letters of recommendation verifying and evaluating the participation in these activities listed in your cover
letter.
5. Resume
Upper Saranac Lake Association Scholarship Application
CRITERIA: Deserving student of good character going on to pursue a college degree.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Brief essay about yourself, what your future plans are and why you feel you would qualify for this scholarship.
4. Resume
V.F.W. Memorial Scholarship In Honor of all Tupper Lake Veterans
Application
Two awards /approximately $1,000.00 each/One time award
CRITERIA: Student will provide a letter written to a veteran, dead or alive telling that person how
you feel about his or her service to our country and what it means to you.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Letter to a veteran as described in the criteria listed above. The letter is to be typed, double spaced and 14pt. font.
Helene Walter Memorial Scholarship Application
CRITERIA:
Awarded to a senior who possesses determination, perseverance and courage.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
4. Resume
Mt. Morris and Whiteface Chapter #106 Order of the Eastern Star
$500.00 first semester and $500.00 for the second semester
CRITERIA: A student accepted to an accredited college or university. Student of average grade,
hard working, serious commitment, high moral standards and demonstrates financial need.
preference will be given to relatives of Eastern Star members.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Cover letter stating why you need the scholarship, what your future plans are, why do you feel you have high moral
standards and what you have done so far in your life that demonstrates this.
The letter should be typed, double spaced and 14 pt. font
4. Resume
St. Thomas Episcopal Church / In Honor of Mary Wilkinson
CRITERIA:
To a graduating senior going on to pursue a career in nursing and who has a good moral background.
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Brief essay about yourself and why you have chosen a career in nursing
4. Resume
Lawrence Wood Memorial Scholarship Application
Tupper Lake Lions
Approximately $300.00 for four years
CRITERIA:
A graduating senior going onto attend an institution of higher education and has
demonstrated involvement in the community
NAME:____________________________________________________________
ADDRESS:_________________________________________________________
1. Application
2. Brief essay about yourself listing past and present involvement in the community, explain why you believe you meet
the criterion of this scholarship and what your future plans are.
3. Two letters of recommendation from the Tupper Lake High School faculty members.
5. Resume

Academic Scholarship Application

Transcription

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