AMARILLO HIGH SCHOOL AMARILLO INDEPENDENT SCHOOL DISTRICT

Counselor's Name: ______

General Scholarship Application for Graduating Seniors for ______ Scholarship

Please supply all the information requested below. A typed application is preferred; black ink must be used. Attach a picture in the indicated block and a copy of your transcript unless the chart indicates one is not required.

Name: ______/ ID Number: ______
Address: ______/ Zip ______/ Phone (___)___-____
Age ______/ Date of Birth ______/ SS#: ___-__-____ / US Citizen: _____
Middle School Attended: ______/ Elementary School ______
Rank in Class ____/_____ GPA: ______/ SAT Comb:______ACT Comp: ______

Names/Occupations/Places of Employment of parents (persons with whom you reside)

·  ______
·  ______

Number of brothers/sisters _____ Ages: ______

How many family members including yourself will be in college next year? _____

List most notable community activities & school related extra-curricular activities during grades 9-12 and "x" the appropriate grade level(s)

Grade
Activities / 12 / 11 / 10 / 9 / Level of Involvement
(i.e. Officer, member, etc.)

List special recognition, awards, and honors received during grade 9-12 and "x" the appropriate grade level(s).

Grade
Special recognition, / 12 / 11 / 10 / 9 / Group or Activity
Awards, or Honors / Sponsoring the Recognition

List and describe any work experience during the last two years.

Grade
Place(s) of Employment / 12 / 11 / 10 / 9 / Job Description

What college do you plan to attend? ______

Estimated college expenses for freshman year $______

Do you and/or your family have some funds set aside to help with college expenses? ______

Have you applied? ______Have you been admitted? ______

What is your proposed college major? ______

Have you applied for federal financial aid using the FAFSA Form? ______

Do you plan to work while in college? ______

STATEMENT OF FINANCIAL NEED

To the Candidate:

Since the element of financial need can be one of the determining factors used by the Scholarship Committees, it is important that complete and accurate information be supplied in the space below. All information, financial or otherwise, furnished the committee is strictly confidential. This information is to be furnished by you and your parent or guardian.

1.  Please indicate parents' combined income range according to most recent income tax returns. (Adjusted gross income)

$0-25,000 / $41,000-55,000 / $71,000-100,000
$25,000-40,000 / $56,000-70,000 / over $100,000

Please explain in your own words your need for financial aid in attending college.

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Student's Signature / Parent's Signature / Date

revised 9/04