AHS Foundation Administered Funds Scholarship Application

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1 Last Name First Name AHS Foundation Administered Funds Scholarship Application Please check all scholarship funds for which you would like to be considered and return to the Alliance High School Guidance office by March 16, (List 1 of 2) AHS Foundation Scholarships John & Roene Klusch Scholarships Beverly Robertson Yeagley Scholarship F. Kermit Donaldson Scholarship Eugene Haidet Scholarship Byron & Isabel Saffell Scholarship Margaret Peach Scholarship James Lear Memorial Scholarship Class of 1963 Scholarship Brett Streza Scholarship Baker Health Scholarship Vietnam Veteran Scholarship Furcolow Family Athletic Scholarship Donna Floyd Scholarship Gary Andreani Scholarship R.G. Hamrick Scholarship Edwin & Ruth Gibson Scholarship Gibson Cliff Trainer Memorial Scholarship (Pursuing Education) (Pursuing Music) (Community Service) (Pursuing History) (Accounting/Business) (school participation, service, athletics) (Nursing/Medical) (Must have a relative of any war (complete and includeform included with this packet; must obtain a DD 214 form for the relative listed) (Must participate in football) (Studying Trades) (Attending University of Mount Union) Hamrick Committee Gibson Committee (Basketball Player - Boy/Girl) Cliff Trainer Memorial Scholarship Committee (Need-based, one female and one male, athletics) 1

2 The following scholarships have a separate application and deadline that must be completed in addition to this application for AHS Foundation Scholarships. The following scholarships will be chosen by different committees. All requested documentation for each individual scholarship must be attached. Megan Adelman Scholarship Cross Country AHS Athletic Dept. - 4 yr letter - Senior * Dorothea & Owen McCoy Scholarship McCoy Scholarship Committee* (Must have 5 years of Foreign Language) Mel Knowlton Scholarship AHS Athletic Department (Must be an athlete) Pietrocola Family Scholarship Rockhill PTO Scholarship David R. and Irene Goldie Mainwaring Pietrocola Family Scholarship Committee (Must be an active volunteer) Rockhill PTO Scholarship Committee (Must have attended Rockhill for 3 years) Mainwaring Scholarship Committee Carli/Cowan Scholarship AHS Math Department Committee (Pursuing math related field) Utterback Family Scholarship Utterback Scholarship Committee (Single parent home, financial need, 3.0 GPA) Class of 1965 Scholarship Chris Penny Memorial Days of Glory Scholarship Class of 1965 Scholarship Committee The Penny committee GPA, good character (Pursuing Music) * If you are eligible for this application, the appropriate AHS Faculty member will personally give you this application. 2

3 AHS Founda on Administered Funds Scholarship Applica on A. Student Informa on: Last Name: First Name: Middle Ini al: Street Address: City: State: Zip Code: Phone: Date of Birth: B. Family Informa on: Parent(s), Legal Guardians Name: Rela onship to Applicant: Occupa on: Annual Gross Income: Name: Rela onship to Applicant: Occupa on: Annual Gross Income: Marital Status: Married Separated Divorced Widowed Single Addi onal Parental Informa on: (Please check all that apply) One or more parent is: Deceased Disabled Re red Addi onal informa on (op onal): Siblings and/ or other dependents in the family Name Age Rela onship College or University if applicable C. College / University Informa on List the colleges/universi es to which you are applying (Must be accredited educa onal ins tu on): Name of Ins tu on 1st Choice: City/State Intended Major: Annual Tui on: Other Fees: Applied: Yes / No Accepted: Yes/No Room and Board: Books: 3

4 AHS Founda on Administered Funds Scholarship Applica on Name of Ins tu on 2nd Choice: Applied: Yes / No City/State Accepted: Yes/No Intended Major: Annual Tui on: Room and Board: Other Fees: Books: Comments: D. Academic Informa on My Class rank is: out of My four year average will be approximately: Based on weighted 5.0 scale Circle Number of years at AHS, including this year: ACT Score: SAT Score: If unusual absence has occurred in the past two years, please explain: YOU MAY CHOOSE TO TYPE ACTIVITIES ON A SEPARATE PAPER PLEASE KEEP SCHOOL ACTIVITIES SEPARATE FROM COMMUNITY ACTIVITIES E. List School Ac vi es, Leadership Posi ons, and Honor Recogni on. Describe ac vity: Years of Par cipa on: Leadership posi ons and/or Awards based on the ac vity 4

5 AHS Founda on Administered Funds Scholarship Applica on COMMUNITY ACTIVITIES THAT ARE SEPARATE FROM SCHOOL Group Name Ac vity descrip on Years of Par cipa on: Leadership posi ons and/or Awards based on the ac vity F. Employment. List all Employment experiences you have had during high school : Employer : Posi on Held Years of Employment G. Addi onal Informa on Please list any other scholarships that you have applied for, or an cipate applying for, and the amount awarded by any such scholarship: Name of Scholarship Amount Awarded Annual or One Time Applica on Status (Intend to apply for, granted, denied) 5

6 USE THIS SPACE OR TYPE ON SEPARATE SHEET AND ATTACH AHS Founda on Administered Funds Scholarship Applica on SUMMARY: DESCRIBE IN DETAIL REASONS WHY YOU SHOULD BE SELECTED FOR SCHOLARSHIPS FROM THE AHS SCHOLARSHIP FOUNDATION: H. TEACHER EVALUATIONS. IMPORTANT! INCLUDE TWO (2) TEACHER EVALUATIONS WITH THIS APPLICATION. I hereby authorize Alliance High School to release official transcripts and all per nent records to the AHS Founda on Scholarship Commi ee. I hereby cer fy that the preceding applica on is true and accurate in all relevant aspects. Signature of parent/guardian Date: Address: City/ State: Phone: Signature of Student: Date: 6

7 APPLICANT: AHS FOUNDATION : REQUIRED FOR VIETNAM VETERANS SCHOLARSHIP APPLICATION ONLY 1. Copy of the related veteran s DD 214 form 2. Applicant s rela onship to the veteran PLEASE HIGHLIGHT OR CIRCLE ONE FATHER MOTHER BROTHER SISTER GRANDFATHER GRANDMOTHER UNCLE AUNT GREAT GRANDFATHER GREAT GRANDMOTHER OTHER: 3. Describe the veteran s service ( example: Navy Veteran): 4. List other informa on you believe is significant about the Veteran: 7