Lavon H. Cooper Scholarship Application
2016-2017
Applications must be postmarked by June 1, 2016.
Late applications will not be considered.
Scholarships will be awarded in September 2016.
Biographical Information
Name: ______________________________________________________________________
Last
First
Middle
Home address: _______________________________________________________________
Number
Street
Apt/Bldg #
_______________________________________________________________
City
State
Zip
Summer address: _____________________________________________________________
Number
Street
Apt/Bldg #
_____________________________________________________________
City
State
Zip
Which address do you wish to receive mail:
Home _____
Summer _____
Home phone: ___________________________
Cell: ____________________________
Email address: ___________________________________
Parents’ names: ___________________________________________________________
(If applicable)
You must be a graduate of a Robbinsdale District 281 high school. Armstrong, Cooper or Highview.
Graduation Year: __________
School: ______________________________
Do not write your name on any of the following pages.
Do not include information not asked for.
If you are downloading this document from the internet,
DO NOT return by email. A hard copy is required.
New Hope Women of Today
Page 1 of 4
Educational Information
You must have completed a minimum of two consecutive semesters or three consecutive
trimesters, whichever is applicable, of post-secondary school education and maintained a G.P.A. of
at least 3.0 on a 4.0 scale (or equivalent) to be eligible for this scholarship.
Post High School Education:
College _____________________________________________ Dates __________________
College _____________________________________________ Dates __________________
Other
_____________________________________________ Dates __________________
Overall G.P.A. __________
College level, Fall 2016
Number of credits to date _______________
Sophomore
Junior
Senior
Graduate School
Major field of study: ___________________________________________________________
Educational objective(s): _______________________________________________________
___________________________________________________________________________
List college and community activities in which you have been or were active and any office, leadership,
teamwork or project positions you held: ____________________________________________
____________________________________________________________________________
____________________________________________________________________________
List any special recognition you have received since high school graduation.
____________________________________________________________________________
Statement of Estimated Resources for School Year 2016 – 2017
Student financial resources available for the 2016-2017 year:
Estimated aid from parents or other family members:
Estimated Loans for 2016-2017(list):
______________________________________
______________________________________
______________________________________
Scholarships/grants (list source):________________________
______________________________________
______________________________________
Government/financial aid (list source):____________________
______________________________________
______________________________________
Other (list source):___________________________________
TOTAL ESTIMATED RESOURCES
$ ___________________
$ ___________________
$ ___________________
$ ___________________
$ ___________________
$ ___________________
$ ___________________
$ ___________________
$ ___________________
$ ___________________
$ ___________________
$ ___________________
$ ___________________
1. Statement of Estimated Expenses for School Year 2016 – 2017
Tuition and fees
Books and supplies
Room and board
Transportation/auto expenses
Personal expenses
Other expenses
TOTAL ESTIMATED EXPENSES
$ ___________________
$ ___________________
$ ___________________
$ ___________________
$ ___________________
$ ___________________
$ ___________________
Page 2 of 4
Biographical/Financial Information
What is your (student) accumulated debt to date for school related expenses (nearest thousand)?
____________________________________________________________________________________
Referring back to the estimated aid from parents or other family members:
If they cannot help financially, briefly explain why. If you are no longer a financial dependent of them, please
note NA and proceed to dependents question.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Number of siblings attending college: __________
Number of siblings your parents support: __________
Their ages: _____________________
Others your parents support? Number and ages. ___________________________________
How many dependents do you have? __________
Any other pertinent information? __________________________________________________
Are you employed? __________
If so, by whom? __________________________________
In what capacity? _____________________________________________________________
Do you plan to work in the summer?
Full-time _____ Part-time _____ non-paid position (ex: job, internship, research, volunteer) _________
Paid and non-paid work experience, beginning with the most recent (or present) employer:
Employer
Position
Dates
Responsibilities
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
New Hope Women of Today
Page 3 of 4
PERSONAL STATEMENT
Write an essay of 200 – 300 words which covers the following:
1.
2.
3.
4.
5.
Your reasons for applying for this scholarship.
Your educational/academic program.
Your probable career goals.
What you hope to be doing five years from now.
Do not put your name on or in the essay.
CERTIFICATION STATEMENT
I certify that the information given on this application is factual and correct to the best of my
knowledge. If at any time there is a significant change in my financial situation, I agree to
immediately notify the scholarship committee.
_____________________________________________
Applicant’s Signature
___________________
Date
MISCELLANEOUS
Please include the following with your completed application:
1. A copy of your transcript with credits earned to date.
2. A business-size, stamped, self-addressed envelope for information to be sent to you regarding
the scholarship awards, with the summer mailing address.
Send your completed application and SASE (self-addressed stamped
envelope) to:
New Hope Women of Today
PO Box 41592
Plymouth, MN 55441
Questions: Email scholarships@newhopewt.org
New Hope Women of Today
Page 4 of 4