PLEASE DO NOT PHOTOCOPY THIS APPLICATION
MARY K GARR SCHOLARSHIP FUND APPLICATION
I.
PERSONAL INFORMATION
1. Name __________________________________
Last
First
Birthdate __________ Sex ____________
Middle
Address ______________________________________________________________________
Street
City
State
Zip
Telephone __________________ E-Mail Address: ___________________________________
A. Have you lived more than one year at current address? _ yes
__ no
If not, please indicate previous address:
__________________________________________________________________________
Street
City
State
Zip
2. Name and address of Father or Guardian: ___________________________________________
______________________________________________________________________________
Street
City
State
Zip
A. Occupation of Father or Guardian: ______________________________________________
3. Name and address of Mother or Guardian: ___________________________________________
______________________________________________________________________________
Street
City
State
Zip
A. Occupation of Mother or Guardian: ______________________________________________
4. Have you ever been convicted of a crime other than a minor traffic violation? ___ yes ___ no
A. If yes, please explain __________________________________________________________
__________________________________________________________________________
5. Are you a United States citizen?
Yes
No
.
II. EDUCATIONAL INFORMATION
1. Name of high school from which you have graduated or will graduate: _____________________
2. Names of educational institutions to which you have applied for admission:
________________________________________________________________________________
Name
Street
City
State
Zip
________________________________________________________________________________
Name
Street
City
State
Zip
________________________________________________________________________________
Name
Street
City
State
Zip
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3. Names of educational institutions to which you have been accepted:
_____________________________________________________
_____________________________________________________
_____________________________________________________
4. Name of educational institutions you wish to attend
(Assuming you have been or will be accepted)
____________________________________________________
III. FINANCIAL INFORMATION
1. Number of children in family excluding yourself _______ Ages __________________________
2. How many are dependent on parents/guardians for support, excluding yourself? _____________
3. How many will be in college next year, excluding yourself? ______________________________
4. Are there others dependent on your family for support? _________________________________
If so, explain ___________________________________________________________________
______________________________________________________________________________
5. Estimate of your financial resources for next academic year:
Savings
_____
Earnings during school year _____
Scholarships or grants (already granted) _______
Family contribution
_______
TOTAL
_______
6. Specify source of scholarship above. _______________________________________________
7. Are you now working?
Yes
____
No _____
Where? __________________________
8. How much do you earn? _____________________
9. What are your plans for summer work? ______________________________________________
10. Estimated expenses for upcoming academic year:
Tuition
Room
Transportation
Miscellaneous
_________________
_________________
_________________
_________________
Books
_________________
Board
_________________
Entertainment _________________
11. Are there any extenuating financial circumstances that you would like the committee to take into
consideration that have not already been mentioned above?
_________________
_________________
_________________
_________________
_________________
_________________
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IV.
SUPPLEMENTAL INFORMATION
1. In the space provided, list your involvement in extra-curricular activities:
A. Athletics
Activity
Year(s) of
Participation
Offices held
Recognitions, Honors, etc.
Year(s) of
Participation
Offices held
Recognitions, Honors, etc.
Year(s) of
Participation
Offices held
Recognitions, Honors, etc.
Year(s) of
Participation
Offices held
Recognitions, Honors, etc.
B. Community Involvement
Activity
C. Social Clubs/Student Government
Activity
D. Other Extracurricular Activities
Activity
2. Work Experience
Dates
Employer-Job Description (be specific)
Average Number of
Hours worked per week
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V. SHORT ANSWER
Attach a brief summary of why you chose your intended course of study, the importance of it in
today’s society, and the important issues facing it today. Please limit this to 150 words.
VI. ESSAY
Choose one of the questions below to answer. Please limit your essay to 300 words.
1.
2.
3.
4.
Who in your life has been your biggest influence and why?
What has been your most significant accomplishment in high school and why?
What do you hope to accomplish once your college career is complete?
Which question do you wish we had asked and how would you respond?
In consideration of my high school record and the facts set forth in this application, I respectfully petition
that a Mary K. Garr Scholarship be awarded to me for the upcoming academic year. I solemnly affirm
that to the best of my ability the information given is correct.
If an award is made to me and I am not accepted by the college named, or if I do not attend school for the
date specified, the granting of this award will be open for reconsideration by the Board.
If a Mary K. Garr Scholarship should be awarded to me, I recognize that I will have a moral obligation to
the other applicants for Garr Scholarships this year to repay any sums paid to me if an investigation
reveals that I have voluntarily failed to continue to demonstrate the qualities which have lead to my
selection.
_______________________________
Signature of Applicant
_______________________________
Date
I, the undersigned parent or guardian of the above applicant, have read and approved the foregoing
application.
_______________________________
(Parent or Guardian)