STANLEY G. ZIMMERMAN SERVICE ABOVE SELF SCHOLARSHIP
"HE PROFITS MOST WHO SERVES BEST"
SCHOLARSHIP ($1000)
(Must be high school senior/ funds to be used at any University)
(Attach recent photo here for publicity purposes. approx
2" x 2")
I.
. PERSONAL INFORMATION
NAME__________________________________________________SS#__________________
SEX ________DATE OF BIRTH__________ MARITAL STATUS_______________________
HOME ADDRESS______________________________________________________________
______________________________________________________PHONE_________________
FATHER_____________________________ OCCUPATION__________________________
MOTHER_____________________________ OCCUPATION__________________________
SIBLINGS (Give name, sex, age, and occupation) _____________________________________
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II. COLLEGE PLANS
1.
AT WHICH COLLEGE OR UNIVERSITY DO YOU PLAN TO ATTEND?
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2. IN WHAT FIELD DO YOU PLAN TO MAJOR? __________________________________
3. IF UNDECIDED, LIST YOUR PREFERENCES. A. ________________________________
B.________________________ C. ______________________________________________
4.
IF YOU HAVE SELECTED AN OCCUPATION OR PROFESSION, LIST IT HERE.
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III. HIGH SCHOOL EDUCATIONAL INFORMATION
1.
FROM WHAT HIGH SCHOOL WILL YOU GRADUATE?
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2. LIST YOUR MOST SIGNIFICANT HONORS, AWARDS, AND EXTRA-CURRICULAR
ACTIVITIES. _________________________________________________________________
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IV. DETAILED BUDGET INFORMATION
INSTRUCTIONS: Please give a detailed budget for the school year when you will use the scholarship. Show amount, sources of funds you expect to get, as well as your work experiences in your lifetime, including what money you have made during the past 12 months and how. Also, are you working now and do you plan to do so in the year these funds will be used? (attach extra sheets if necessary)
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ATTACH A PAGE WITH COMMENTS WHICH YOU WOULD LIKE TO MAKE THAT
MAY HAVE A BEARING ON THE DECISION OF THE SCHOLARSHIP AWARDS
COMMITTEE. INCLUDE WHY YOU SELECTED THE COLLEGE OR UNIVERSITY YOU
WISH TO ATTEND WHILE USING THIS SCHOLARSHIP, AND OTHER FACTORS THAT
DEMONSTRATE MERIT AND/OR NEED.

TO BE FILLED OUT BY THE APPROPRIATE SCHOOL OFFICIAL AFTER APPLICANT
HAS COMPLETED THE PREVIOUS SECTIONS
1. PLEASE INCLUDE TRANSCRIPT TO INCLUDE CURRENT SEMESTER
2. NUMBER IN APPLICANTS GRADUATING CLASS___________.
APPLICANT'S RANK (IF KNOWN)___________.
3. GRADE POINT AVERAGE __________ SCALE USED _______________.
4. AMERICAN COLLEGE TEST RESULTS (Please report in standard scores.)
ENGLISH __________ MATH __________ READING __________
SCIENCE REASONING __________ COMPOSITE __________
5. SAT.: VERBAL __________ MATH __________
6. RECOMMENDATIONS OR REMARKS FOR THE SCHOLARSHIP AWARDS
COMMITTEE. _______________________________________________________________
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DATE _______________ SIGNED _____________________________________
PRINTED NAME _____________________________
TITLE ______________________________________
7. PLEASE LIST THE SCHOOL OFFICIAL(S) TO BE NOTIFIED IF THE SCHOLARSHIP
IS AWARDED.
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CONSENT FOR RELEASE OF STUDENT INFORMATION
I hereby give my permission to the Scholarship Awards Committee to publicly announce my special achievement. If such recognition involves reviewing my gradepoint average and scholastic record, this committee has my permission to use such information. I also authorize the committee to share my application with any interested community club or organization for the purpose of awarding scholarships.
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(Social Security Number)
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(Date)
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(Student’s Signature)
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(Parent’s Signature)