Denton County A&M Club
2017 Scholarship Application
Deadline for submission is April 1st, 2017
Personal Information:
Name: ______Social Security Number: _____-_____-_____
Address:______Phone Number: ______
______
Parental Information:
Father’s Name: ______Mother’s Name: ______
Father’s Address:______Mother’s Address:______
______
______
Home Phone: ______Home Phone: ______
Work Phone: ______Work Phone: ______
Father’s Employer: ______Mother’s Employer: ______
Father’s Occupation: ______Mother’s Occupation ______
Father’s Annual Income: $ ______Mother’s Annual Income: $______
May we verify with employer? (circle): Yes / No May we verify with employer? (circle): Yes / No
Do you have family that is attending or has attended Number of Brothers/Sisters in College? ______
Texas A&M University? (list below) Number of Brothers/Sisters at Home? ______
______Class of______
______Class of______
______Class of______
Other Scholarships:
List other scholarships, total amount of scholarship and current status (Received or Applied for):
1)______$______R / A 2)______$______R / A
3)______$______R / A 4)______$______R / A
5)______$______R / A 6)______$______R / A
School Records:
The following information should be supplied by your High School Counselor and must be signed and dated as verification.
High School Name______Date of Verification:______
Class Standing ______out of ______Counselor’s Name:______
Grade Point Avg.: ______Counselor’s Phone:______
On What Scale (3.0, 4.0, 12.0 etc.)?______Counselor’s Signature:______
High School Activities:
Extracurricular Activities (Clubs, Sports, Band, Civic Activities, etc.)
______
______
______
______
Academic/Sports Awards, Honors, Achievements
______
______
______
Work Experience (summer and/or after school)
______
______
General Information: Please attach any additional pages if necessary
Briefly describe your long-term career goals (after college): ______
Briefly describe what makes you a particularly outstanding candidate for this scholarship: ______
University Information:
What is your admission status at Texas A&M? Will you be a member of the Corps of Cadets?
ACCEPTED PENDING YES NO
What is your anticipated major? Have you visited the Texas A&M Campus?
______YES NO
I certify that the above information is true and correct to the best of my knowledge. I understand that failure to complete the application in its entirety may result in elimination of my application from consideration by the Denton County A&M Club Scholarship Committee. If I am selected to receive this scholarship, the Denton County A&M Club is authorized to use any or all of the information contained in this application in newspapers, magazine’s or brochures for the purpose of promoting this scholarship except for the information under the heading SCHOOL RECORDS, information related to family income and my Social Security Number.
Applicant’s Signature: ______Date: ______
Parent/Guardian’s Signature: ______Date: ______
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