MOUNT VERNON HIGH SCHOOL MEMORIAL SCHOLARSHIP FUND

SCHOLARSHIP APPLICATION

For Mount Vernon Senior Students graduating from a Grant County High School.

The MVHS Memorial Scholarship Fund was established June 21, 2003 by the MVHS alumni classes of 1955 through 1959. The purpose of the fund is to provide scholarship opportunities to senior students who will graduate from a Grant County High School and live within the historical boundaries of the previously known Mount Vernon School District Number Six.

The awarded funds will be made available to the recipient. If the award is not used within eighteen months, the grant will revert to the scholarship fund.

CRITERIA: Recipients will be selected on the basis of academic excellence, financial need, extra-curricular activities, special awards and honors, and involvement with and service to the Mount Vernon Community. Applicants must live within the Mount Vernon School District Number Six historical boundaries; graduate from a Grant County High School; and be accepted to an accredited college, university or trade school.

APPLICATION REQUIREMENTS

  1. A completed application form.
  2. An official high school transcript through your senior year fall semester.
  3. Letter of acceptance from a college, school or university.
  4. Recommendations from a school teacher and a Mount Vernon community citizen.
  5. Scholastic Aptitude Test (SAT), American College Test (ACT) and/or COMPASS Placement score(s).
  6. A statement summarizing your educational and career goals.
  7. A photograph of yourself.

YOUR APPLICATION IS NOT COMPLETE WITHOUT THE ABOVE ITEMS.

EQUAL OPPORTUNITY STATEMENT

We do not discriminate against any applicant because of race,

color, sex, sexual orientation, nationality, age, religion, or disability.

PRIVACY ACT INFORMATION

This information is provided pursuant to the Privacy Act 9f 1975 (5 U.S.C. & 552A).

Information from your completed application form is used to determine scholarship awards by the MVHS Memorial Scholarship Fund. Information is disclosed only to the Fund Board of Directors. High standards are used to safeguard and protect your nonpublic information. Your name and personal information is never rented or sold to third parties or marketers. Personal information may be disclosed to government agencies and regulatory organizations when required by law.

MOUNT VERNON MEMORIAL SCHOLARSHIP FUND

PERSONAL INFORMATION

NAME: ______DATE OF BIRTH: ______

MAILING ADDRESS: ______

______PHONE NO. ______

STREET ADDRESS: ______

CITY, STATE & ZIP CODE: ______

I have lived in the Mt. Vernon community From ______To ______

PRESENT EMPLOYER (IF APPLICABLE) ______

PARENT/GUARDIAN NAME: ______

ADDRESS: ______

EMPLOYER:______

PARENT/GUARDIAN NAME: ______

ADDRESS: ______

EMPLOYER: ______

OTHER CHILDREN

IN YOUR FAMILY: Name: ______Age: ______

Name: ______Age: ______

Name: ______Age: ______

Name: ______Age: ______

ACADEMIC INFORMATION

HIGH SCHOOL(S) ATTENDED:

Freshman ______

Sophomore ______

Junior ______

Senior ______

CURRENT CUMULATIVE GRADE POINT AVERAGE: ______

____ Official transcript attached. ____ Transcript will be mailed by my high school

SAT Scores ______(If taken, attach official results)

ACT Scores______(If taken, attach official results)

COMPASS Placement Scores______(If taken, attach official results)

MOUNT. VERNON HIGH SCHOOL MEMORIAL SCHOLARSHIP FUND

NAME: ______

LIST SPECIAL HONORS AND AWARDS RECEIVED:

LIST SCHOOL ACTIVITIES AND ORGANIZATIONS:

LIST AND DESCRIBE VOLUNTEER ACTIVITIES/SERVICES:

  1. Within the Mt. Vernon community
  1. Within the Grant County area
  1. Other volunteer activities/services

If more space is required, use back of page or attach another page

MOUNT VERNON HIGH SCHOOL MEMORIAL SCHOLARSHIP FUND

NAME: ______

At what college, university or trade school will you be using this scholarship?

Name of College, University or School: ______

Address: ______

City, State, Zip Code: ______

Attach a copy of your Letter of Acceptance, or authorized document showing intent to begin or continue studies at said institution. Full name of school and mailing address must accompany application.

REFERENCES

  1. Use the enclosed evaluation form for your teacher recommendation.

Teacher’s Name: ______

  1. Letter of Recommendation on a plain sheet of paper must be received from a non-relative Mount Vernon Citizen Name:______

Reference letters must be mailed to the Scholarship Committee under separate cover.

I certify that to the best of my knowledge the information contained in this application is correct and complete. I authorize the Committee to verify the information given. I give the Committee permission to use my name in their news releases, brochures and fund raising activities.

______

Signature of applicant Date

______

SCHOLARSHIP APPLICATION AND OTHER DOCUMENTS MUST BE POSTMARKED OR DELIVERED NO LATER THANMAY 1 TO:

RICHARD HEHN

7827 MOUNTAIN AIRE LOOP SE

OLYMPIA, WA 98503

MOUNT. VERNON HIGH SCHOOL MEMORIAL SCHOLARSHIP FUND

NAME: ______

FINANCIAL INFORMATION

Financial information is required as one of the criteria for the selection process.

Does your family claim you as a dependent on their tax return? Yes ____ No ____

Annual income for your family: ______

Complete the following estimated budget for the upcoming school year:

RECEIPTS EXPENSES

Available Savings ______Tuition ______

Anticipated Income

(sPummer jobs, etc) ______Estimated Fees ______

Funding from Parents ______Books & Supplies ______

Scholarships/Grants ______Room & Board ______

Loans (Actual) ______Sub Total ______

Loans (Proposed) ______Personal expenses(clothes,

entertainment, medical) ______

Transportation to/from school ______

TOTAL ______TOTAL ______

Important information not covered by your proposed budget:

Describe family status affecting your scholarship needs (i.e. other dependents in college or private school, childcare expenses, illness or disability in family, etc.).

MOUNT VERNON HIGH SCHOOL MEMORIAL SCHOLARSHIP FUND

NAME______

Summarize your educational and career goals below.

ATTACH YOUR PHOTOGRAPH TO THIS PAGE

MOUNT VERNON HIGH SCHOOL MEMORIAL SCHOLARSHIP

TEACHER RECOMMENDATION/REFERENCE FORM

Please complete this form to assist the Scholarship Committee to evaluate the worthiness of the student listed below. Mail the form to RICHARD HEHN, 7827 MOUNTAIN AIRE L00P SE, OLYMPIA, WA 98503 prior to the May 1st deadline. Thank you for your time and assistance.

APPLICANT’S NAME ______

  1. DEMONSTRATED ACADEMIC EXCELLENCE:
  1. COMMUNITY INVOLVEMENT:
  1. SCHOOL ACTIVITIES, AWARDS, AND HONORS:
  1. OTHER RELEVANT COMMENTS:

Your Name: ______Signature: ______

Position/Title: ______Years Acquainted with Student: _____

If more space is required, use back of page or attach another page