Class of 2015 General Local Scholarship Application

Return this application and 1 copy of your essay to the Counseling Office by December 5, 2014

Name: ______Major of study ______

GPA: ______ACT/SAT: ______Rank (Counseling Department will provide student rank

to benefactors when rank is available)

Address: ______City: ______

Phone: ______E-Mail:______

Father: ______Place of Employment: ______

Mother: ______Place of Employment: ______

Parents: (check)___ Live together ___ Divorced___Separated

Whom do you live with? ______

Are/was your parent /grandparent a veteran of war? Yes____, if so list where: ______

Parent: ______Grandparent: ______

Are you presently employed? (Check) __ Yes__ No if yes, where: ______

Family income:Under $25,000 _____$25,000-50,000 _____

$50,000-75,000 _____ $75,000-100,000 _____

Over $100,000______

Number in your household: _____Number of college students in household: ______

To your knowledge will you be receiving a grant or any scholarship? ______

If yes, list below:

ScholarshipAmount ($)

School or college you plan to attend: ______

On a separate sheet of paper, please write an essay stating any factors you think you should be considered in your application, such as financial needs hardships, etc. Also list all extracurricular activities such as clubs, awards, honors, volunteer work, church activities and community

service.

Be Sure to Complete the Checksheet on the Back

By submitting an application, you are applying for all scholarships listed in this section.

Scholarship

/ Notes
Agee Oil Scholarship / All seniors may apply
Alan Hooper Memorial Scholarship / All seniors may apply
Brandon Elder Scholarship / All seniors may apply
Class of 1966 / All seniors may apply
Class of 1969 / All seniors may apply
Clyde Thomas Family Trust Memorial / All Seniors may apply
Dailey & Vincent / All seniors may apply
David Wayne Alexander Memorial / All seniors may apply
DCHS PTO / All seniors may apply
DeKalb County Foundation for Education
Mentor Scholarship / All seniors may apply
DeKalb Democratic Party / All seniors may apply
DeKalb Funeral Chapel / All seniors may apply
Eddie Crips Memorial Scholarship / All seniors may apply
First Bank Scholarship / All seniors may apply
Jeff Garrett Memorial Scholarship / All seniors may apply
Jolly Angels Scholarship / All seniors may apply
Liberty State Bank Scholarship / All seniors may apply
Love-Cantrell Funeral Home Scholarship / All seniors may apply
Scottish Rite / All seniors may apply
Smithville Rotary Club / All seniors may apply
If you are applying for any scholarships in this section, please check in appropriate box.

Scholarship

/ Notes / Check all you
qualify for
AMVETS / Auxiliary Scholarship / For students who are children or grandchildren of a veteran
DeKalb Community Hospital Scholarship / For students going into healthcare field
Brandon Elder Music Scholarship / For students going to MTSU and majoring in music or recording
Farm Bureau Young Farmers and Ranchers / Preference given to students majoring in Agriculture / Separate App.
available at a later date
DeKalb Firefighters Association / Student’s parent or grandparent must be a current member of the DeKalb Firefighter’s Association.
DeKalb Retired Teachers / For students who will major in education
DeKalb Soil Conservation District / For students majoring in Agriculture / Separate App.
DTC / All students may apply / Separate App.
available at a later date
Duane Trapp Memorial / For student athletes
Elzie & Nell McBride / Future MTSU Students Only
Jake McClain Driver Scholarship / Amateur Radio Operator
Kyle & Kenny Robinson Memorial Scholarship / For student athletes
Lucille Stewart Memorial Scholarship / Students going into the teaching field
Nell Haas Driver Scholarship / Female Basketball Players
Smithville Business & Professional Women / Female Students Only
Smithville Women’s Club / Female only

Please sign verifying you have read and understand all that you are applying for: ______

Student Signature

Page 1 of 2 Applications due by December 05, 2014