PIZZA HUT OF ARIZONA, INC./KYTE SCHOLARSHIP APPLICATION CHECKLIST

Transcription

1 PIZZA HUT OF ARIZONA, INC./KYTE SCHOLARSHIP APPLICATION CHECKLIST Applicant s Name: Instructions Please print legibly. Your application must contain the following items to be complete. Please use paperclips rather than staples on the application materials. Check if attached: 1. This completed and signed Checklist (page 1). 2. Completed application (page 2-5). 3. Typed essay. 4. This is a need-based scholarship. If you are applying for financial aid at the school you will be attending, a Student Aid Report (SAR) generated by the Free Application for Federal Student Aid (FAFSA) is required. 5. If you are a dependent on your parents /guardians 1040 Tax Return, the first page ONLY of their 1040 Tax Return showing Adjusted Gross Income (AGI) is required. If current year tax returns have not been filed by the application deadline, last year s tax returns are acceptable. 6. If you are self-supporting, the first page ONLY of your 1040 Tax Return showing Adjust Gross Income (AGI) is required. If current year tax returns have not been filed by the application deadline, last year s tax returns are acceptable. 7. If you are applying for financial aid, the Financial Aid Notification Letters from the schools to which you are applying are required. If not attached, please state reason (not applying or not yet received). 8. Attach a one-page resume of your employment, volunteer service, or extracurricular activities for the last 3 years. 9. One letter of recommendation from someone who is familiar with your academic career in a sealed envelope with the recommender s signature over the seal. 10. For a graduating high school senior, provide a high school transcript. For an applicant who is already in college, provide a college transcript. These do not need to be official copies. Applications must be received no later than Friday, March 11, 2016 by 3:00 p.m. Applications may be ed to Marthena Maley at mmaley@cfsaz.org, mailed (must be postmarked by March 10) or handdelivered to the Community Foundation for Southern Arizona, 2250 E. Broadway Boulevard, Tucson, AZ Office hours are 8:00 a.m. to 5:00 p.m. Monday through Friday. For more information, please review the Pizza Hut of Arizona, Inc./Kyte Scholarship Guidelines & Instructions at under Scholarship & Awards or contact Marthena Maley at the Community Foundation for Southern Arizona at mmaley@cfsaz.org. I certify that all the information in my application and additional documentation is true and complete to the best of my knowledge. If asked by the Community Foundation for Southern Arizona (CFSA), I (we) agree to give documentation for information given on this form. I (we) realize that failure to comply with a request for information may prevent the applicant from being considered for a scholarship. I (we) understand that falsification of any information may result in the termination of the scholarship. I (we) understand that the signature of Pizza Hut of Arizona, Inc. Human Resources is required to verify eligibility. If I am selected as a recipient of a Pizza Hut of Arizona, Inc./Kyte Scholarship, I agree to permit CFSA to confer with my school to verify my continuing enrollment during the term of my scholarship. I also agree that my name can be used in announcements made by the Community Foundation for Southern Arizona or Pizza Hut of Arizona, Inc. regarding the scholarship I have been awarded. Applicant Signature Date Human Resources Signature Date Parent/Guardian Signature (if student is not 18) Date 1 P age

2 PIZZA HUT OF ARIZONA, INC./KYTE SCHOLARSHIP APPLICATION APPLICANT Name: First Middle Last Mailing Address: Street City State Zip Permanent Address: (if different from above) Street City State Zip Home Phone: Cell: VERY IMPORTANT! This is how we will contact you with any questions and to send you award notification. Please add to your address book to avoid s going to SPAM. SSN or Permanent Residency Number: ACADEMICS If you are already in college, skip this section. Date of Birth: Month/Day/Year High School Name City/State Expected Graduation Date ACT Composite: SAT Critical Thinking: SAT Math: SAT Written: GPA Scale: GPA: College Complete if you are already in college. If you are still in high school and have not finalized your college choice, provide your first choice school. School Name School Type: (2-year; 4-year; vocational) School State: Degree Sought: Major/Field of Study: Full-time or Part-time: Class standing in the fall semester: For high school students: Have you been Yes accepted? (circle one) GPA: A transcript is required. No Are you intending on transferring schools in the next academic year? (circle one) Yes No If yes, indicate the schools you are applying to. 2 Page

3 Applicant Name: FINANCIAL All information provided in this section is confidential. Name of person whose employment qualifies you for this scholarship program: Title/Position: Hours/Week: Circle relationship to applicant: Self Parent Guardian Parent 1 Father/stepfather/guardian status (circle one): Living Deceased Name of father/stepfather/guardian who assists with your expenses: Occupation: Employer: Parent 2 Mother/stepmother/guardian status (circle one): Living Deceased Name of mother/stepmother/guardian who assists with your expenses: Occupation: Employer: Household Information Number of people living in your household, including yourself: List name, age and relationship of all individuals supported by your parent/guardian. Indicate if any of them are going to college or vocational school. If the individual does not attend college, enter N/A under college. Name Age Relationship School Expected Graduation Financial Aid Are you applying for financial aid at the school you will be attending (circle one): Yes No If yes, indicate the month/year you applied. If yes, have you received a Financial Aid Notification Letter? Yes No This is a need-based scholarship. If you are applying for financial aid at the school you will be attending, you are required to submit a FAFSA with your application. If you have received your Financial Aid Notification Letter, be sure to include a copy in your application packet. 3 P age

4 Applicant Name: Indicate the financial aid you have applied for. If more than allowed below, attach typed list. Type of Assistance Amount Indicate all scholarships, loans, waivers, and/or grants you have applied for from other sources for the academic year. If more than allowed below, attach typed list. Status (approved, Date Applied Type of Funding Amount pending, declined) Are you currently making payments on any loans (car, credit cards, etc.) Yes No If yes, what is the monthly payment and total balance on these loans? Monthly payment Total balance Are you planning on working while attending college? (circle one) Yes No If yes, indicate how many hours per week. Unusual Financial Circumstances Statement (Optional) Describe any unusual personal or family circumstances affecting your need for financial assistance. Describe any financial hardships endured by you and your family that will make it difficult to afford your education (family member is unemployed; any medical expenses not covered by insurance; multiple individuals attending college at the same time; or any other circumstances that affect income). Attach a typed statement, maximum word count 300. Essay Attach a typed essay, maximum word count 500, which answers the following questions: 1. Some students have a background or story that is so central to their identity that they believe their application would be incomplete without it. If this sounds like you, then please share your story. 2. We may encounter many defeats, but we must not be defeated, Maya Angelou said. Explain a time when you overcame an obstacle. What did you learn from the experience? How will you use this knowledge to improve your life and the lives of others? 4 P age

5 Letter of Recommendation One letter of recommendation from someone who is familiar with your academic career is required. The recommendation letter can be submitted with your application or mailed directly by the recommender to: Marthena Maley, Program Officer, Community Foundation for Southern Arizona, 2250 E. Broadway Blvd., Tucson AZ It is your responsibility to follow-up with your recommender to ensure they have submitted the letter. If your recommender mails the letter, it must be post-marked by March 10. If you deliver the letter with your application packet, the recommender must seal the letter in an envelope with a signature over the seal. Supplemental Documents to the Application Check if attached: 1. The completed and signed Checklist (page 1). 2. Completed application (page 2-5). 3. Typed essay. 4. This is a need-based scholarship. If you are applying for financial aid at the school you will be attending, a Student Aid Report (SAR) generated by the Free Application for Federal Student Aid (FAFSA) is required. 5. If you are a dependent on your parents /guardians 1040 Tax Return, the first page ONLY of their 1040 Tax Return showing Adjusted Gross Income (AGI) is required. If current year tax returns have not been filed by the application deadline, last year s tax returns are acceptable. 6. If you are self-supporting, the first page ONLY of your 1040 Tax Return showing Adjust Gross Income (AGI) is required. If current year tax returns have not been filed by the application deadline, last year s tax returns are acceptable. 7. If you are applying for financial aid, the Financial Aid Notification Letters from the schools to which you are applying are required. If not attached, please state reason (not applying or not yet received). 8. Attach a one-page resume of your employment, volunteer service, or extracurricular activities for the last 3 years. 9. One letter of recommendation from someone who is familiar with your academic career. 10.For a graduating high school senior, a high school transcript. For an applicant who is already in college, provide a college transcript. These do not need to be official copies. 5 P age