Jim and Paula Palmer Scholarship Application 1

/ JIM AND PAULA PALMER SCHOLARSHIP

PURPOSETo provide college tuition assistance for students with plans to pursue a degree in Education (specifically teaching) or Engineering (any type) from an accredited college or university.

DEADLINEApril 15, 2013

AMOUNT$4,000.00

ELIGIBILITYStudents selected to receive the scholarship must:

  • be a graduating senior from Camas High School, Camas, WA
  • plan to attend an accredited four-year college or university, full-time, beginning Fall 2013
  • have already been accepted by the college or university
  • have financial need

REQUIRED DOCUMENTS /
  • An official sealed copy of your high school transcript. (Online transcripts and grade reports will not be accepted).
  • A copy of your acceptance letters from colleges and/or universities.
  • A one-page essay, describing why you have chosen your specific area of study and your specific career goals.
  • A half-page essay, describing your financial need.
Applications and attachments must be typewritten in 12-point font and stapled together in the top left-hand corner.Incomplete packets and those not following all guidelines will be ineligible for consideration.
SUBMISSION / Completed application packets must be MAILED OR DELIVERED to:
Jim and Paula Palmer Scholarship
Camas High School
Ms. Suzie Downs, Career Center
26900 SE 15th Street
Camas, WA 96707-7296
Applications will not be returned.It is recommended that you keep a copy for your files.All information will remain confidential.

SELECTIONInformation from the application and attached materials is reviewed by the scholarship advisory committee. Recipients are recommended by this committee to the Community Foundation board of directors.

NOTIFICATIONTherecipient is sent an award letter from the Community Foundation for Southwest Washington. Applicants not selected to receive a scholarship are also sent written notification.

QUESTIONSIf you have questions, please contact:

Anne Digenis, Donor Services and Grants Officer

Community Foundation for Southwest Washington

360.694.2550 or

As you fill out this application, please think about what your career goals are, what your community means to you, and what you, as a citizen hope to offer to make your community a better place to live.

Last Name: / First Name: / Middle Initial:
Permanent Mailing Address:
City: / State: / Zip Code:
Home Phone: / Cell Phone:
College Student ID#: / Email Address:

List school activities: (max. 400 characters)

List academic achievements/honors: (max. 400 characters)

List community involvement/service: (max. 400 characters)

List employment history:

Employer / Position / Start Date / End Date / Hours Per Week

How did you hear about this scholarship opportunity?

Community Foundation Website / The WashBoard.org
High School Counselor / Other:

Please list the institutions you have been accepted to as of the date of this application. Please include acceptance letters with this application (see required documents). (max. 400 characters)

Which institution do you plan to attend?

Start date:

Complete the following information based on annual costs:

Tuition
Books and Fees
Room and Board

Have you filed the FAFSA form for the 2013/2014 school year? YesNo

If yes, what is your estimated family contribution (EFC) amount?

List scholarships and financial aid you are applying for (or have applied for) and amount of each, for the 2013/2014 school year. Also, please include Work/Study and student and parent loans.

Name of Scholarship, Grantor
Other Type of Financial Aid / Received? / Amount ($) / If not yet received,
date you expect to be
notified of decision.
YesNo
YesNo
YesNo
YesNo
YesNo

Unusual Circumstances:If applicable, please describe how and when any unusual family or personal circumstances have affected your achievement in school, work experience, or your participation in school and community activities. (max. 500 characters)

Please complete the CERTIFICATION section on the following page.

I acknowledge that this is a competitive selection process and that decisions of the Scholarship Advisory Committee and the Community Foundation for Southwest Washington are final.

I understand that incomplete applications will not be considered.

I certify that the information provided is complete and accurate to the best of my knowledge. I understand that intentional misrepresentation is cause for disqualification of theJim and Paula Palmer Scholarship. I understand that the scholarship advisory committee shall review information on this form and all attachments and, if asked, I agree to provide proof of information I have given on this form.

I give permission for the scholarship advisory committee to contact my references for additional work or character reference information.

Applicant’s Signature ______Date ______

If selected to receive a scholarship, I give permission for a publicity release, including the use of my name and photographic image.

Applicant’s Signature ______Date ______

/ Please mail or deliver completed application packet by April 15, 2013 to:
The Community Foundation for Southwest Washington
1053 Officers Row, Vancouver WA, 98661
360.694.2550