Strongsville High School
Local Scholarship Application
2014
HINTS FOR COMPLETING THIS APPLICATION
1.
Answer all questions. Use N/A if any question is not applicable.
2.
Type, if possible. If not, print or write neatly in ink.
3.
If spaces provided aren’t sufficient, please use the back or attach a separate
sheet.
Deadline:
APRIL 4, 2014 AT 3:00 P.M.
Guidance Office
1
For Office Use Only: Application #
Student Section – Part 1
Please type or print in ink.
Name: _______________________________________________________________________
Last
First
Parent/Guardian: _______________________________________________________________
Home Address: ________________________________________________________________
Street
Zip
Phone: _______________________________________________________________________
Home
Cell
__________________________
____________________________________
Date of Application
Student Signature
Parent Section
______
I give permission for my child’s name to be used in district publications
acknowledging that he/she is a scholarship recipient.
______
I have read the following scholarship application and certify that the information
provided is correct.
______________________________
____________________________________
Date of Application
Signature of Parent/Guardian
2
For Office Use Only
Date Received: _____________ Application No. _____________ Cumulative GPA ________
Please check one:
________SHS Student ________ Polaris ________ PSEOP
Colleges , universities, or technical schools where you have applied:
1. ___________________________________________
2. ___________________________________________
3. ___________________________________________
4. ___________________________________________
5. ___________________________________________
6. ___________________________________________
Intended College Major(s): _______________________________________________________
Make a brief statement discussing your post high school plans and why you have chosen this
field(s).
Have you enlisted in the military? Yes
No
If yes, which branch did you enlist: _________________________________________________
3
Number of children in your family (excluding yourself)?
Number of children currently in college supported by the family
Father’s
Occupation
Mother’s
Occupation
Explain any special circumstances that would affect this scholarship application:
Are your parents members of Strongsville PTA? Yes
No
What elementary and middle school did you attend and for how long?
School
Years
School
Chapman
Kinsner
Drake
Surrarrer
Muraski
Zellers
Whitney
Center
Years
Albion
Other school(s)
Do you have a current
IEP
504?
Do you plan to participate in interscholastic sports in college?
If yes, will you receive monetary assistance?
Yes
4
Yes
No
No
Activities in school (performing arts, athletics, student organizations, etc.)
List in order of their importance to you.
Years participated
(please circle)
1. Name of activity
9th 10th 11th 12th
Your role or contribution
Leadership position(s) held
2. Name of activity
9th 10th 11th 12th
Your role or contribution
Leadership position(s) held
3. Name of activity
9th 10th 11th 12th
Your role or contribution
Leadership position(s) held
4. Name of activity
9th 10th 11th 12th
Your role or contribution
Leadership position(s) held
5. Name of activity
9th 10th 11th 12th
Your role or contribution
Leadership position(s) held
6. Name of activity
9th 10th 11th 12th
Your role or contribution
Leadership position(s) held
7. Name of activity
9th 10th 11th 12th
Your role or contribution
Leadership position(s) held
5
Activities out of school (performing arts; community service; scouting, religious, cultural, or
ethnic organizations, etc.) Spell out acronyms, please.
Years participated
(please circle)
1. Name of activity
9th 10th 11th 12th
Your role or contribution
Leadership position(s) held
2. Name of activity
9th 10th 11th 12th
Your role or contribution
Leadership position(s) held
3. Name of activity
9th 10th 11th 12th
Your role or contribution
Leadership position(s) held
4. Name of activity
9th 10th 11th 12th
Your role or contribution
Leadership position(s) held
5. Name of activity
9th 10th 11th 12th
Your role or contribution
Leadership position(s) held
Work Experience
From
(mo.yr)
To
(mo.yr)
Employer
Job Description
6
No. of hours
worked/week