Student ID#
JASON BERGER SCHOLARSHIP APPLICATION 2017
Application Deadline April 28, 2017
PLEASE ANSWER ALL QUESTIONS AS COMPLETELY AS POSSIBLE. IF ADDITIONAL SPACE IS NEEDED, ATTACH AN ADDITIONAL SHEET OF PAPER. APPLICATION DEADLINE IS 2:30 P.M. April 28th, 2017.
Name (Last) (First) (Middle Initial)
Address
(Street) (City) (State) (Zip)
Date of Birth Elementary School Attended
Middle/Junior High Attended
Parent/Guardian Information
Father’s/Guardian’s Name
Address
(Street) (City) (State) (Zip)
Homeowner: Yes No
Occupation Name of Employer
Address of Employer
(Street) (City) (State) (Zip)
If retired, former employer
Mother’s/Guardian’s Name
Homeowner: Yes No
Occupation Name of Employer
Address of Employer
(Street) (City) (State) (Zip)
If retired, former employer
Please indicate if mother or father is a firefighter or police officer or a retired firefighter or police officer.
Firefighter Yes No Police Officer Yes No
List brothers and sisters living at home or at school:
1. Age School
2. Age School
3. Age School
JASON BERGER SCHOLARSHIP STUDENT INFORMATION
List and verify the schools where you have been accepted: (Attach Photocopy of Acceptance letter/Guidance counselor verification)
1. 2.
3. 4.
List the school you Major:
plan to attend:
Have you applied for any scholarships, loans, or financial aid? Yes (Attach Photo copy) No
If yes, please list what aid
you have applied for
List any loans, scholarships, or financial aid that you have received to date (Attach photocopy)
Student Employment Information
Employer Type of Work Hr. Per Week
Extracurricular Activities & Volunteer Activities
List any school, volunteer, church or other activities that you participated in during high school and approximate time per week devoted to them (Use additional sheet if necessary or attach a resume.)
Activity/Organization Type of Involvement Years Hrs Per Week
Family Circumstances
Explain any additional or extraordinary circumstances affecting your family situation, which would warrant your receiving financial aid. (Use additional sheet if necessary)
Please answer the following question.
How will this scholarship money support your ability to go to and succeed in college? How does college support your long-term life goals? Are you the first in your family to attend college? Please explain.
*This amount pertains to only students who are commuting to school on a daily basis.
In consideration of my financial need and academic record, I respectfully petition that a scholarship be awarded to me. If any award is made to me and I do not attend school for the date specified, the granting of the award will be void.
I attest that this information is complete and true to the best of my knowledge.
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