Zach Jones Memorial Fund
Scholarship Application
Please complete all sections of this application by typing or printing, using black ink. Use N/A if
a question does not apply. Appearance and completeness of application will be considered
during evaluation. Mail to the Zach Jones Memorial Fund, 6942 FM 1960 E., # 330, Humble,
TX 77346-2706. All sections must be completed in order for application to be considered.
The application must be postmarked by March 1
I.
PERSONAL INFORMATION
A.
Full name_______________________________ SS#______________________
B.
Home address______________________________________________________
_________________________________________________________________
C.
Full name of school currently attending__________________________________
School address_____________________________________________________
D.
Home telephone ___________________ School telephone__________________
E.
Cell Phone ___________ Email address _______________________________
F.
Present age___________ Date of birth__________________________________
G.
Country of citizenship_______________________________________________
H.
Parent or legal guardian’s name________________________________________
Address__________________________________________________________
I.
What four adjectives have others used to describe you?
1.
___________________________________________________________
2.
___________________________________________________________
3.
___________________________________________________________
4.
___________________________________________________________
Revised June 25, 2007
J.
K.
What do you perceive as your four strongest attributes?
1.
____________________________________________________________
2.
____________________________________________________________
3.
____________________________________________________________
4.
____________________________________________________________
Please list two references and submit a letter of recommendation from each.
1.
Name_______________________________________________________
Relationship_________________________________________________
Address_____________________________________________________
Telephone___________________________________________________
2.
Name_______________________________________________________
Relationship_________________________________________________
Address_____________________________________________________
Telephone___________________________________________________
I agree that the application and the attachments may be used for the purpose of evaluation and
selection by the Scholarship Committee. I also state that all information enclosed is true and
correct to the best of my knowledge. False information is cause for disqualification.
Signature_________________________________________________Date_________________
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II.
EMPLOYMENT HISTORY
List below full-time employment, summer employment, or other part-time employment,
briefly explain duties and responsibilities (beginning with your most recent job). If parttime employment, indicate number of hours per week. Add additional sheets as
necessary.
A.
Dates employed_____________________________________________________
Company__________________________________________________________
Address___________________________________________________________
Supervisors Name______________________________Phone________________
Position___________________________________________________________
Your duties________________________________________________________
B.
Dates employed_____________________________________________________
Company__________________________________________________________
Address___________________________________________________________
Supervisors Name______________________________Phone________________
Position___________________________________________________________
Your duties________________________________________________________
III.
FINANCIAL INFORMATION (Complete all blanks)
A.
Father’s occupation__________________________________________________
Income  20k to 30k
 30k to 40k
 40k to 60k
 60k & up
B.
Mother’s occupation_________________________________________________
Income  20k to 30k
 30k to 40k
 40k to 60k
 60k & up
C. Please attach a copy of page one and two of your parent’s prior year Form1040
tax return form. You may choose to cover Social Security numbers. These will be shredded after
application has been processed.
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IV.
SCHOLASTIC INFORMATION
A.
What is your cumulative grade point average?
As of which semester completed?
Senior fall
GPA: ______________
Senior spring
B.
IMPORTANT! Attach an official transcript from the high school you are
presently attending.
C.
In what extracurricular activities have you participated while attending high
school? Indicate elected offices held, if any. Specify purpose of local
organization. Add additional sheets as necessary.
D.
1.
Student activities (student government, Key Club, National Honor
Society, etc.)
____________________________________________________________
____________________________________________________________
____________________________________________________________
2.
Community activities (Boy Scouts, Girl Scouts, etc.)
____________________________________________________________
____________________________________________________________
____________________________________________________________
3.
Athletics
____________________________________________________________
____________________________________________________________
____________________________________________________________
4.
Other Activities
____________________________________________________________
____________________________________________________________
____________________________________________________________
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V. ADDITIONAL INFORMATION
Answer the following questions using only the space provided. Any additional sheets
will not be considered.
A.
Why are you interested in your career choice and what event, or series of events have
led you to this decision? Where possible, explain how your previous work
experiences will relate to your career.
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
B.
What has been your most important extracurricular activity, your most important
contribution to it, and what has your participation in it meant to you as an individual?
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
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C. What college or vocational school do you plan to attend? If your final decision
has not yet been made, indicate which schools you are considering, listing the most
likely choice first and others in descending order.
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
ESSAY
In 250 - 500 words, describe how your work ethic, your academic endeavors, and your
participation in athletics and/or Fine Arts have contributed to the development of your
character, and how they will affect your future educational and career aspirations.
*Athletics is not a requirement for our scholarship.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Application Checklist
Please include:
Transcript of Grades
Essay
Postmarked before March 1st
Two letters of recommendation
Financial Information 1040 form
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