SCHOLARSHIP APPLICATION FOR FIRST TIME APPLICANTS
MARY GRAHAM FOUNDATION
PERSONAL INFORMATION
APPLICANT NAME:
Last
First
Social Security Number
ADDRESS:
Age
Middle
Birthdate
Street/PO Box
Telephone
(
)
CITY, STATE, ZIP
Number of Children:
Email Address:
ETHNIC GROUP (CIRCLE ONE):
1. White
2. Hispanic
3. Black
4. Other Asian or Pacific Islander
5. Alaskan Native or American Indian
6. Filipino
7. Chinese
8. Cambodian
9. Japanese
10. Korean
11. Samoan
12. Hawaiian
13.Guamanian
14. Laotian
15.Vietnamese
EDUCATIONAL BACKGROUND
I will graduate from or did graduate from:
(Please
attach copy of
transcript):
GPA
School (Name and City)_________________________________________________ Date:(Mo/Dy/Yr) _____________________
_________
Academic Honors or Achievements:
Extracurricular Activities (Track, Band, or other activities):
I plan to attend: (Name of College/Vocational School , City and State)
I have applied for admission. [ ] YES [ ] NO
I have been accepted. [ ] YES [ ] NO
I have applied for financial aid. [ ] YES [ ] NO
I have applied for the Chafee Grant. [
] YES [ ] NO
EMPLOYMENT EXPERIENCE
Are you working now? [
] YES [
] NO
If YES, complete part A below. If NO, skip part A and complete part B below.
A
Numbers of Hours Weekly
Check () Appropriate Box Below:
Full-time Employment _________
Part-time Employment _________
Type of Employment and Job Title:
Describe Duties and Responsibilities:
Do you plan to continue to work to help with school expenses? [
B
Do you plan to find work to help with school expenses? [
Describe past work or volunteer experience you have had:
MARY GRAHAM FOUNDATION SCHOLARSHIP APPLICATION
] YES [
] YES [
] NO
] NO
If you were a previous scholarship recipient and are reapplying, please list what has changed since the last
time you were awarded a scholarship by the Mary Graham Foundation:
MARY GRAHAM FOUNDATION SCHOLARSHIP APPLICATION
PERSONAL STATEMENTS
INSTRUCTIONS: Answer the following questions in the space provided below.
Attach additional pages if necessary.
What abilities, achievements, activities, etc. do you think best qualify you for this scholarship?
What are your educational and occupational goals?
Signature
Date
MARY GRAHAM FOUNDATION SCHOLARSHIP APPLICATION
FINANCIAL PLANNING
Youth Name _____________________________________ Academic Year: ____________
Make your best estimate of what your budget will look like for the YEAR.
ESTIMATED BUDGET FOR THE SCHOLARSHIP YEAR
ESTIMATED RESOURCES (A)
ESTIMATES EXPENSES (B)
Personal Savings
$
Tuition and Fees
$
Expected Summer wages
$
Books and Supplies
$
Expected School Year wages
$
Rent
$
Pell Grant
$
Transportation
$
Cal Grant
$
Child Care Costs (if any)
$
Outside Scholarships
$
Clothing
$
AB12
$
Food
$
Transitional Housing Program
Phone
Food Stamps
Electricity
Other Income:
TOTAL (A)
$
TOTAL (B)
$
Amount needed to balance budget: TOTAL Estimated Resources (Column A)
$
TOTAL Estimated Exspenses(Column B)
$
UNMET NEED (Total A minus Total B = )
$
Are you in a Transitional Housing Program? □Yes □No
If Yes, which program are you in:________________________________
Contact number for program you are in:_____________________________
How much longer are you in the program?___________________________
Additional Notes to Financial Planning if any: