Lakes Region Tourism Association of New Hampshire
Scholarship Fund (2016)
Student Application Form
2016 Scholarship up to $1,000
ELIGIBILITY: the student may complete this application before notification of college acceptance
however only those students accepted at an institution of higher learning majoring and/or
studying a tourism or hospitality related field would be eligible for the scholarship. One must be a
New Hampshire resident to be eligible to receive this scholarship. One can be awarded this
scholarship for a maximum of two years.
The following criteria are used to evaluate scholarship applicants: personal data,
recommendations, scholastic aptitude, scholastic performance, essay and financial need.
1. NAME: _______________________________________________________
First
Middle
Last
PHONE: _______________
_
2. HOME ADDRESS: ______________________________________________
Street
City
State
ZIP
INTRODUCTION: It is important to complete each item on the application form
as accurately as possible. Please provide a complete picture of yourself and
your background to help the committee make a fair evaluation of your
application.
3. Date New Hampshire residence was established: _________________
4. Father’s Occupation: ___________________________
Employer: ______________________ City/Town ________________
Mother’s Occupation: ___________________________
Employer: ______________________ City/Town ________________
Guardian’s Occupation: _________________________
Employer: ______________________ City/Town ________________
5. Brothers and/or Sisters living at home or at college: (circle as applicable)
Name: __________________ Age: __ Part/Full time Employment/School___
Name: __________________ Age: __ Part/Full time Employment/School___
Name: __________________ Age: __ Part/Full time Employment/School___
Name: __________________ Age: __ Part/Full time Employment/School___
Name: __________________ Age: __ Part/Full time Employment/School___
Name: __________________ Age: __ Part/Full time Employment/School___
6. Application must be accompanied by high school transcript and College Board
(SAT or ACT) scores and college or university grades transcript (if applicable).
A. Current high school or college level _________________________
7. Post secondary school or college for which applicant’s scholarship is
requested:
Name of school/college: _____________________________________
City/State/Zip: _____________________________________________
Anticipated Major: __________________________________________
7a.
What other scholarships have you been awarded and in what amounts?
Please list the name of scholarship, who provided the scholarship and the
scholarship amount:
Name of Scholarship
Scholarship Provider
Amount
Year
8. Describe your interests and or hobbies:
________________________________________________________________
________________________________________________________________
9. List participation in school, community organizations and activities over the
past four years: Do not attach a Resume.
Organization/Activity
FRESHMAN YEAR
________________________
________________________
________________________
________________________
________________________
________________________
# Months
Status in organization/activity
_______
_______
_______
_______
_______
_______
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
Organization/Activity
SOPHMORE YEAR
________________________
________________________
________________________
________________________
________________________
________________________
# Months
Status in organization/activity
_______
_______
_______
_______
_______
_______
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
Organization/Activity
JUNIOR YEAR
________________________
________________________
________________________
________________________
________________________
________________________
# Months
Status in organization/activity
_______
_______
_______
_______
_______
_______
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
Organization/Activity
SENIOR YEAR
________________________
________________________
________________________
________________________
________________________
________________________
# Months
Status in organization/activity
_______
_______
_______
_______
_______
_______
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
10. Describe your work experiences. Indicate periods of employment in each
job and list amounts earned on each job over the past four years:
________________________________________________________________
Employer
Job Description
# Weeks Worked
Average # hours/week
_____________________________________________________________________________
Employer
Job Description
# Weeks Worked
Average # hours/week
_____________________________________________________________________________
Employer
Job Description
# Weeks Worked
Average # hours/week
_____________________________________________________________________________
Employer
Job Description
# Weeks Worked
Average # hours/week
_____________________________________________________________________________
Employer
Job Description
# Weeks Worked
Average # hours/week
_____________________________________________________________________________
Employer
Job Description
# Weeks Worked
Average # hours/week
11. What did you learn from your work experiences?
12. Submit three short essays of 250 to 500 words each describing:
A. Have you experienced a moment of epiphany, as if your eyes were
opened to something you were previously blind to? Describe this moment
and the impact that this revelation has had on you.
B. Why are you pursuing a degree and or training in the tourism/hospitality
industry?
C. Explain or describe a career opportunity in tourism/hospitality in the State
of New Hampshire.
13. State any other personal circumstances you feel warrant the attention of the
selection committee:
14. Is there any other information that you believe might be helpful to the
selection committee? You may include any awards or recognitions.
15. How did you first learn the availability of the Ron Meade “On the Track to
Tourism” Scholarship?
16. The Lakes Region Tourism Association provides information to the media
about scholarship recipients to help in promoting the Scholarship Auction and
upcoming scholarship opportunities. Given what you have provided for personal
information in this application, please write four or five sentences about yourself
that the Association can use to inform the public about you.
17. Two letters of recommendation must be enclosed with your application to
include:
1. First recommendation – Teacher
2. Second recommendation – Guidance Counselor, Principal, Employer or
Clergy. Please note, letters must be written within the current academic
year.
18. Complete the Financial Information Worksheet. See last two pages of this
application.
19. Signature: ________________________________
Date: ___________
Applications must be received by 3:00PM at the Lakes Region Tourism
Association on March 25, 2016.
Address:
Lakes Region Tourism Association
PO Box 737
Tilton, NH 03276
IMPORTANT!!!!! Please remember to attach your transcripts, SAT and/or
ACT scores and references. If you are presently in college, send a copy of
all your transcript and SAT scores.
Lakes Region Tourism Association Scholarship Fund
Scholarship Application 2016
FINANCIAL INFORMATION WORKSHEET
1. Complete the following information related to the college/university for
which you plan to attend.
Tuition:
$_________________
Room & Board:
$ ________________
Books:
$ ________________
Other fees:
$ ________________
Total Costs:
$ ________________
2. Indicate sources of financial assistance for the upcoming school year.
Other scholarship secured:
$ __________________
Student loans:
$ __________________
Grants:
$ __________________
Parent expected contribution:
$ __________________
Employer (student/parent):
$ __________________
Other relatives’ contribution:
$ __________________
Other (please state below*):
$ __________________
Total Assistance:
$ __________________
(*Other Sources):
Lakes Region Tourism Association
Scholarship Application 2016
FINANCIAL INFORMATION WORKSHEET (CONTINUED)
3. Student 2015 Income + Assets (MUST BE COMPLETED)
A. Indicate 2015 US Tax Return adjusted gross income from IRS form
1040 line 33, or 1040A line 19, or 1040EZ line 4: $ _______________
B. Indicate expected summer/school year income for 2016/2017
Summer 2016 (3 months)
$ ___________
School year 2016/17 (10 months) $ ___________
C. Indicate student cash, savings, CD’s,
and checking accounts:
$ ___________
D. Indicate value of any student’s trust:
$ ___________
E. Indicate value of any student owned
Stocks or Bonds:
$ ___________
F. Indicate value of any 529 College
Funding plans:
$ ___________
4. Parents combined 2016 expected total income from all sources: (select
one)
___ $0 - $24999
__ $75000 - $99999
___ $25000 - $49999
__ $100000 - $124999
___ $50000 - $74999
__ $125000 - $149999
End of application
__ $150000 + up