(Completed scholarship applications must be received in GMC Prep School Office (201 Usery Hall) not later than March 8, 2012.)
Student’s Grade (2012-2013): _____ Student’s Name: _____________________ _________________ ___________________________
First Middle Last
Student’s Mailing Address: ___________________________________________________________
Street or P. O. Box Number
___________________________________________________________
City State Zip Code
Student Lives With: ____ Parents ____Mother ____Father ____ Other: ___________________________________
Parent(s)/Legal Guardian’s Name ______________________________________ _______________________________________
Mother Father
Home Phone: (____)_______________ Mother’s Work Phone: (____)________________ Father’s Work Phone: (____)_________________
1. Number of family members in household 2012-2013: _____ (Include parents, yourself and any other persons who get more than half their support from your parents)
2. Number of family members in household attending Georgia Military College Prep School in 2012-2013 ______ Please list:
Name ______________________________ Grade _______ Name _________________________________ Grade ________
Name ______________________________ Grade _______ Name _________________________________ Grade ________
3. Number of family members in household attending Georgia Military College in 2012-2013 ______ Please list:
Name ____________________________ Name _____________________________ Name _____________________________
4. Number of family members in household who will be attending college other than any listed in #3 above in 2012-2013 _______
Name ____________________________ Name _____________________________ Name _____________________________
Total Family Income:
0 - $14,999 $30,000 - $44,999
$15,000 - $29,999 $45,000 or above
I hereby declare that I will maintain a satisfactory scholastic and discipline record at GMC. ____________________________________________________
Student’s Signature
I hereby apply for consideration for the Lillian Womble Baugh Trust and authorize the school to release whatever information it deems necessary to the members of the Lillian Womble Baugh Trust. My reasons for applying for the Trust are (Explain any unusual expense, educational and other debts or special circumstances):
________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
___________________________________________________
Parent/Guardian Signature
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For School Use Only
Academic Average: _________ Discipline Record: No. of In School Suspensions ___________ No. of At Home Suspensions ___________
Current Student - Date received __________________ Prospective Student - Date Received __________________