Lovettsville-Waterford Ruritan Entrepreneur Grant
The Buddy Williams Memorial Award
Amount: $1,500
Objective: One grant will be awarded to a student who has started a business/is starting a business and
needs an investment of capital either to pay for technical training, licensing, needed equipment
or supplies. Business Plan must be submitted. Interviews will be required.
Applicant must:
Be U.S. citizen and resident of the Lovettsville/Waterford area with a zip code of either 20180 or
20197 during their junior and senior years
Submit High School transcript
Demonstrate financial need
Demonstrate involvement in school activities and/or employment
Demonstrate community service
Funds will be paid to third party; student’s technical/vocational institution, equipment or supplies
provider. Funds will not be paid directly to student.
Selection by Lovettsville-Waterford Ruritan Scholarship Committee
Applicants must use the L-W Ruritan Application Form
Deadline: April 8, 2015
LOVETTSVILLE-WATERFORD RURITAN ENTREPRENEUR GRANT
THE BUDDY WILLIAMS MEMORIAL AWARD
APPLICATION FORM
Please provide your answers in essay form. Please include additional pages as necessary.
Please type or print clearly all answers and essays.
DEADLINE: April 8, 2015
SSN:
Name
_____________________________________________________________________
Address ______________________________
City
______________________________
Phone_________________________________
Phone ___________________________
ZIP _______________________
Date of Birth:________________________
Parent(s) or Guardian(s)_________________________________________________________
Accepted by: (college or universities)_______________________________________________
Class Standing (to be filled in by counselor
GPA___________ RANK_______
Scholastic honors
If you have been employed during the last two (2) years, please list your employment during
high school (starting with most recent employer):
FROM
TO
EMPLOYER
REASON
FOR
LEAVING
Describe how you help your family:
Extra-curricular activities (describe the activity, include number of years and offices held)
Community activities (describe the activity, include number of years and offices held)
Describe your planned course of study and educational goals
Essays:
1Discuss how you have significantly contributed either to your school
environment and your community through your volunteer activities:
2. Explain how you will benefit from this scholarship:
I have completed the above Application Form and the information that I
have provided is true, correct, and complete to the best of my
knowledge. I understand that providing false information will result in
recall of the scholarship and that I will be financially responsible to
return all money to the Lovettsville-Waterford Ruritans.
_________________________________
_______________
Applicant Signature
Date
FINANCIAL STATEMENT
I. Student Employment (includes full or part-time during the last two years
EMPLOYER
TYPE OF WORK
EMPLOYED
FROM
TO
WEEKLY
Amount you have saved toward higher education_______________________________________
Family Income
OCCUPATION
ANNUAL INCOME
Father
Mother
*Other
*Specify by source, such as Social Security, Veteran’s benefits, income of other family members, or investment
income.
I.
Estimated Expenses for one school year:
Tuition & fees
Transportation
Room and Board
Clothing
Books & Supplies
Medical, incl. Insurance
Laundry
Other
TOTAL EST. EXPENSES
II.
Expected Financial Resources (per year):
From Family
From earnings
*From other sources
III.
Name
From other scholarships
From Contributions
TOTAL EXPECTED RESOUCES
*Specify by source, such as trust funds, insurance, etc.
Other dependents in family
Age
If student name the school
I/we declare the information in this application and financial statement to be true and accurate, to the best of my/our knowledge.
Signature of Student
Signature of Parent(s) or Guardian(s)
I authorize the release of transcript to the Scholarship Committee so that he/she may be considered for this scholarship.
Signature of student
Signature of parent if student is under 18
Date
Date