Crowder College - Foundation Scholarship

FOUNDATION SCHOLARSHIPS

All fields with a * must be filled in, unless they do not apply to you.

Name:
Last * First *
Social Security Number: * Date of Birth: *
Address *
City * State * Zip *

Sex (Optional): Male Female
Race (optional)

Name of High School * Graduation Date *

High School Rank * of * #graduated GED Date *

If college transfer student, cumulative GPA *

Name of College * and last date of attendance *

PLEASE SEND TRANSCRIPTS Major *

Anticipated college of attendance *

PLEASE SEND PROOF OF COLLEGE ENROLLMENT

List scholastic honors in high school and/or college *

Please indicate the major activities you have participated in during high school and/or college *

Scholarships are awarded based upon the financial need of the student. If you wish to be considered for a Scholarship, you must provide complete financial information. Fill in only the information appropriate to your situation. Do not leave a line blank. Blank lines will be considered an incomplete application. If the question does not apply to you, enter NA.

Financial Information

(THIS SECTION MUST BE COMPLETED TO BE CONSIDERED FOR A SCHOLARSHIP)
MUST BE COMPLETED BY ALL APPLICANTS

1. Total number of people in household *

	a. Names and ages of everyone living in your home *
	Name*	Age*
	Name*	Age*
	Name*	Age *
	Name*	Age*
	Name*	Age*
	Name *	Age*
	Name*	Age*
	Name*	Age*
	Name*	Age*

2. Please list any other scholarships (include name of the award and amount) *

	Award*	Amount*
	Award*	Amount*
	Award*	Amount*
	Award*	Amount*
	Award*	Amount*

3. Please explain any unusual family circumstances which have a bearing on family financial support for the college student. Include such items as unusual illness, misfortunes, or other pertinent information not included elsewhere.*

Answer the following questions for each of the individuals listed below.

1. Total family income from all sources last year before taxes or withholding.*
2. Annual income from nontaxable sources (Social Security, child support, welfare, AFDC, GI Bill, etc.)*
3. If self-employed, explain nature of business*

Student*	Spouse*	Father*	Mother*	Any Person Providing Household Income*
1.
2.
3.

Nature of Self-Employment*

Statement of certification: I hereby give consent for the Scholarship Committee to review my complete academic records. I also consent to the release of my name to the news media in the event I am awarded a Scholarship.

Name * Date*
Hometown Newspaper* City*

Scholarships are awarded without regard to race, color, national origin, sex, age, and qualified disabled.