Currenthigh School Or College Academic Transcript

PanolaCollege
Endowed Scholarship Application

Complete and return a copy of this application to the Office of Institutional Advancement along with the following:

[ ] CurrentHigh School or College academic transcript

[ ] One letter of recommendation

[ ] Complete the Free Application for Federal Student Aid (FAFSA) in the Financial Aid Office

[ ] Attach a brief summary of the reasons you are applying for a scholarship to PanolaCollege

Student Identification or Social Security Number______

Name ______

Address ______

(Street or P O Box)(City)(State)(Zip)

Phone______Email Address ______

Date of Birth______Place of Birth______

(City) (County) (State)

Citizen of U.S. _____Yes _____NoResident of Texas_____Yes _____No Resident of ______County

Student’s Employer______Occupation______

Spouse’s Employer______Occupation______

Estimated 2014 Gross Family Income $______Estimated 2015 Gross Family Income $______

Number of Dependent Children in Family______Ages of Dependent Children in Family______

Number of Other Dependents in Family______Number of Children in College______

List other scholarships or financial resources such as the G.I. Bill, Social Security or Fellowships that you will receive for the academic year in which you are applying______

______

List previous scholarships at PC and amounts received______

If you are a dependent student, please complete the section below. If you are not a dependent student please proceed to the next page. (You are considered to be dependent if you have been claimed on a parent’s State and Federal tax forms.)

Parent’s Name ______

Parent’s Address______

(Street or P O Box)(City)(County)(State)(Zip)

Will this be your primary residence while attending PanolaCollege? _____Yes _____No Phone______

Father’s Employer______Occupation______

Mother’s Employer______Occupation______

Estimated 2014 Gross Family Income $______Estimated 2015 Gross Family Income $______

Number of Dependent Children in Family______Ages of Dependent Children in Family______

Number of Other Dependents in Family______Number of Children in College______

Class Standing at PC during 2015-2016 will be:______Beginning Freshman______Freshman______Sophomore

High School Attended______

(Name)(City)(State)(County)

Date Graduated from High School______ClassRank______out of______

High School Grade Point Average (if incoming freshman) ______College Grade Point Average______

ListHigh School Activities and Honors______

______

At PanolaCollege I plan to major in ______ExpectedCollege Graduation Date______

PC Organization Affiliations ______

• Have you been accepted to PanolaCollege’s associate degree nursing program?_____Yes _____No

• Have you been accepted to PanolaCollege’s licensed vocational nursing program?_____Yes _____No

• Will you be a member of the PanolaCollege intercollegiate baseball team or

a manager or student acting in the capacity of secretary for the program?_____Yes _____No

• Are you currently employed by, or the dependent or spouse of an employee working for
  the Louisiana-Pacific Corporation’s Carthage facility?_____Yes _____No

• Were you born in Russia, Ukraine, Belarus, Poland, or other Eastern European country?_____Yes _____No

• Are you of Middle Eastern descent?_____Yes _____No

• Are you a spouse, dependent child, or grandchild of a member of the
  Panola County VFW Post 5620? _____Yes _____No

• Do you currently reside in PanolaCounty’s third precinct?_____Yes _____No

• Have you served and been honorably discharged from the U.S. military, are you currently_____Yes _____No

serving, or are you a dependent of military personnel killed or missing in action?

• Are you currently employed by, or the spouse or dependent of an employee working for
  the First State Bank & Trust Co, CarthageTexas?_____Yes _____No

• Are you a member of the CentralBaptistChurch in Carthage, Texas?_____Yes _____No

• Were you an active member of 4-H or your high school FFA program?______Yes ______No

APPLICANT’S CERTIFICATION:

To the best of my knowledge the information reported above is complete and correct. I agree to inform the PanolaCollege Financial Aid Office of any major changes in my financial status if I am awarded a scholarship. I understand that to be considered for a scholarship I must apply each year.

Date______Signature of Applicant______

AUTHORIZATION FOR RELEASE OF EDUCATIONAL INFORMATION:

By my signature below, I authorize the release of Educational Information to parties who need this information to check on the status of my progress at PanolaCollege.

Date______Signature of Applicant______