MONTGOMERY COUNTY R-II HIGH SCHOOL

 

LOCAL SCHOLARSHIP FORM

 

 

Last Name:    First Name:  Middle Initial:     

Date of Birth:  Phone Number:    (ex:  555-555-5555)  SS#: 
 

Street Address:    City:    ZIP: 

  

Elementary Schools Attended:     Middle Schools Attended:
 

High Schools Attended:  

 

Parent/Guardian Name:  

 

Parent’s place of employment/Position:    

 

Number of brothers & sisters living at home:        Number attending higher education:      

 

Are they receiving financial assistance?  Yes        No  

 

What is your proposed major in college/vocational program:   

 

Name of University, College, Vocational or Trade School you plan to attend:  

 

Date you expect to enter:    Length of Program:       

 

In the budget form below, please list your anticipated expenses & your resources for meeting these costs for the school year.

 

EXPENSES                                                            RESOURCES:

Tuition & Fees                    Summer Savings            

Books & Supplies               Parents Contribution    

Room & Board                   Loans                            

Misc Expenses                    Part Time Job               
                                                                            A+ Eligibility                

                                                                            Other Income                

 Total Expenses                   Total                                   

 

 

The following information will be provided by the Guidance Counselor.

 

Cum. GPA:                          Rank:                                    ACT Composite:        

                  (7TH Semester)

 

Number of Absences:   9th             10th             11th             12th /thru 1st semester        

 

 

_______________________________________

    Counselor’s Signature

 

List your Senior Year Classes: 

  

Please list your involvement in extracurricular activities during your 4 years of high school and how you contributed to those groups? (School, Church, Community 4-H, etc) (attachments accepted):

  

  

Academic Awards and Honors:  

     

 

Briefly, tell us about your educational and career goals and how you will help make our world a better place in which to live:   

 

Please tell us why you should be considered for this scholarship: (earn not deserve)

 

State the qualities you possess and your accomplishments that qualify you as a scholarship winner:  

     

 

Write a brief paragraph stating how you feel about attending a higher education institution and how it will help you achieve the goals you have set for yourself:  

   

  

Please tell us about any work experience that you may have had:

Where employed                                              Primary Responsibility                                                                                Dates

 

Character reference:

   

 

I agree that if I am a recipient of a scholarship, I will use it for expenses related to my education.  I further understand that if I fail to complete the 1st Semester or term that I have or will enroll, the Club or organization may request that the full amount of the Scholarship (s) be returned and if so requested I will comply with that request.

 

If I earn a scholarship, I will be responsible for providing documentation of my enrollment in college or school and contacting the club or organization as to how and where the funds will be distributed.

 

The information on this application is true to the best of my knowledge.  I also understand that this application can be disqualified if I knowingly falsified any of the information that I have provided.
 

DATE    Applicant's Signature__________________________________   

 

FBLA SCHOLARSHIP (only)

 

List Business courses taken in High School

Number of years in FBLA:        

 

Offices held:       

 

Awards & Honors received through FBLA membership:

       

 

Montgomery Education Association – MEA  and the Helen Posey Memorial Scholarships (only)

(Must be majoring in Education)

 

Father’s annual income (before taxes):       

Mother’s annual income (before taxes):        

 

Are other dependents receiving financial assistance for college expenses? (Enter Yes or No)

 

If so, how much?    

 

Write a short essay on your reasons for choosing a career in education:  

  

WALKER TRIANGLE SCHOLARSHIP (only)

(must be a member of the First United Methodist-Presbyterian Church in Montgomery City)

 

Please list church activities in which you are, or have been involved and indicate length of involvement:

  

 

THE LAVON COLBERT HONORARY SCHOLARSHIP (only)

 

1.                  One-page essay on “Why I am Choosing an Office or Business-Related Career or “Vocation”.

 

2.                  Two letters of recommendations – from non-family members.  Letters may be from school officials, teachers, former or present employers, or others who should describe the student’s activities and leadership record; character, personality, initiative, drive, home background, and/or other factors supporting his/her candidacy.  Letterhead stationary, where appropriate, is required.  All materials should be typed.

  

“PENNY DAY” SCHOLARSHIP (only)

 

Why would you like to be a “Penny Day” scholarship winner?  Also state the qualities you possess and what accomplishments have you had to qualify you as a scholarship winner?

 

MONTGOMERY CITY LIONS INTERNATIONAL SCHOLARSHIP (only)

 

 

Provide a typed summary (100-200) words in length:  (1) telling what you intend to do after graduation, (2) Why you chose your occupation, (3) How would you use the Scholarship if awarded, and (4) How do you feel this career choice will be able to change with Technology, to keep you employed, and enables you to be a worthy member of society.