Swatara Middle School Parent Teacher Student Organization

SCHOLARSHIP APPLICATION

SPONSORED BY

SWATARA MIDDLE SCHOOL PARENT TEACHER STUDENT ORGANIZATION

I, _________________________________________, hereby make application for the Swatara Middle School Parent Teacher Student Organization (PTSO) Scholarship sponsored by the Swatara Middle School PTO. I understand the conditions of eligibility, the criteria for selection, and the selection procedure under which the scholarship is awarded. I authorize the scholarship selection committee, as established by the Swatara Middle School PTSO, to make the necessary inquiries, including the obtaining of transcripts as to my record and standing in all schools that I have attended.

I request that this, my formal application for a scholarship, be given consideration and do affirm that all information contained herein is, to the best of my knowledge, true and correct.

If I should be awarded a scholarship and begin study at a post-secondary institution and leave voluntarily or involuntarily prior to the completion of the first semester/trimester, I will repay the Swatara Middle School PTSO the fully awarded scholarship amount.

________________________________________ ____________________________________

Signature of Applicant Address of Applicant

________________________________________ ____________________________________

Name of Institution Applicant Plans to Attend Date of Application for Scholarship

*Concurrence of Parent or Guardian*

I hereby concur with the above application and agree to all of the provisions thereof.

________________________________________ ____________________________________

Signature of Parent or Guardian Address

________________________________________

Address of Parent or Guardian

SWATARA MIDDLE SCHOOL PARENT TEACHER STUDENT ORGANIZATION SCHOLARSHIP APPLICATION

The following questions are designed to collect information about your background, your interests, and your future plans. If some important aspect of your life is not included in this application questionnaire, please make any additional comments you think are appropriate on a separate sheet of paper and attach it to this application.

The answers you provide will only be used for purposes of this scholarship program and will only be divulged to members of the Swatara Middle School Parent Teacher Student Organization Scholarship Selection Committee.

PLEASE PRINT LEGIBLY

A. Personal Information.

Full Name: __________________________________________________ Sex: M_____ F_____

(Last) (First) (Middle)

Address: ______________________________________________________________________

(Street) (City or Town) (State) (Zip Code)

Birth date: ________________________ Telephone Number: (______) _______-_________

(mm/dd/yyyy)

B. Family Information.

Father’s Full Name: _____________________________________________________________

Home Address (if different from above):_____________________________________________

Father’s Occupation: _____________________________Employer:_______________________

Mother’s Full Name: ____________________________________________________________

Home Address (if different from above):_____________________________________________

Mother’s Occupation: ____________________________Employer:_______________________

Name of parent(s) or guardian(s) who support you: ____________________________________

If you have listed the name of someone other than you father or mother as the person who supports you, please give the following information about him/her:

Home Address: _________________________________________________________________

Relationship to you: ____________________________Occupation:_______________________

Employer: _____________________________________________________________________

Total Family Income: _____ $0 - $40,000 _____ $40,000 - $60,000 _____ $60,000 - $80,000

_____ $80,000 +

Name(s) of Siblings Age School Attending

______________________________________________________________________________

C. School Information.

Grades completed and dates attended Swatara Middle School:

Middle Grade Completed From Year To Year

______________________________________________________________________________

High School from which you will graduate: __________________________________________

D. Activities.

List any extracurricular and/or community activities in which you participated during your high school years. Indicate any positions of leadership you held in these activities.

______________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

List any academic distinctions or other honors you have received.

E. Work Experience.

List any employment you have held in the past two years.

Job Employer Dates Approx. #

of Employment hours/week

______________________________________________________________________________

F. Estimated Expenditures.

Please list all forms and amounts of financial aid definitely made available to you for the

2017-2018 academic year.

Type Amount

__________________________________________ ______________________________

Fill in the items in the table below as accurately as you can to show your budget for the 2017-2018 academic year. If necessary, consult the catalog of the institution you plan to attend for help in estimating the following expenses:

Name of Institution: _____________________________________________________________

Cost of Tuition: ________________________________________________________________

Fees: _________________________________________________________________________

Books and Materials: ____________________________________________________________

Health and Insurance: ___________________________________________________________

Room and Board: _______________________________________________________________

Total Expenses: ________________________________________________________________

G. Essay.

Please write a one-page narrative of no more than 250 words explaining what course of study you plan to pursue after high school and why you feel you should receive this scholarship. The narrative should be placed on 8 ½ x 11 paper and properly attached to the completed scholarship application.

SWATARA MIDDLE SCHOOL PTSO SCHOLARSHIP

Recommendation Form

Name of Applicant: _____________________________________________________________

The student whose name appears above has applied for a Swatara Middle School Parent Teacher Student Organization (PTSO) scholarship to help finance his/her post-secondary education. The Scholarship Selection Committee would like your appraisal of the applicant, i.e., his/her personal and academic characteristics that would attest to his/her ability to profit from study at a post-secondary institution. Please give your impressions of the applicant’s character, strengths and weaknesses, significant contributions to the high school and/or community, and sense of responsibility.

SWATARA MIDDLE SCHOOL PTSO SCHOLARSHIP

Recommendation Form

Name of Applicant: _____________________________________________________________