ALPHA DELTA KAPPA SCHOLARSHIP APPLICATION

DEADLINE: 4/4/2018

Name: ______

High School: ______

Address: ______

Phone #: ______

Parent(s) or Guardian(s):______

Accepted by (College or University):______

Class Standing (To be filled in and signed by counselor; please attach transcript)

GPA: ______Rank: ____ Counselor’s Signature: ______

Scholastic Honors:

Extracurricular Activities (including # of years and offices held):

Volunteer Activities:

Community Activities (including # of years and offices held):

Please reply to the following questions in essay form. Use another sheet if necessary.

Describe your planned course of studies and educational goals and tell why you have selected this field:

Explain why you need and will benefit from the Alpha Delta Kappa Scholarship:

FINANCIAL STATEMENT
I. Student Employment (includes full or part-time during the last two years
EMPLOYER / TYPE OF WORK / EMPLOYED
FROM TO / WEEKLY EARNING

Amount you have saved toward higher education______

FAMILY INCOME / OCCUPATION / ANNUAL INCOME
Father
Mother
*Other

*Specify by source, such as Social Security, Veteran’s benefits, income of other family members, or investment income.

  1. Estimated Expenses for one school year:

Tuition & Fees / Transportation
Room and Board / Clothing
Books & Supplies / Laundry
Medical, incl. Insurance / Other
TOTAL EST. EXPENSES
  1. Expected Financial Resources (per year):

From family / Confirmed:
From earnings / College scholarships/grants
*From other sources / Confirmed from non-local scholarships
From a College Saving Plan
TOTAL EXPECTED RESOUCES

*Specify by source, such as trust funds, insurance, etc.

  1. Other dependents in family:

Name / Age / If student name the school
I/we declare the information in this application and financial statement to be true and accurate, to the best of my/our knowledge.
Signature of Student / Signature of Parent(s) or Guardian(s)
I authorize the release of transcript to the Scholarship Committee so that he/she may be considered for this scholarship.
Signature of student / Signature of parent if student is under 18
Date / Date