Community Foundation of Fayette County
2 West Main Street, Suite 101
Uniontown, PA 15401
724-437-8600
2017 College Scholarship Application
Instructions:
Please print clearly and use ONE paper clip on the entire application. DO NOT STAPLE.
All required documents must be attached. Incomplete applications will not be accepted.
Applications must be post-marked by March 24, 2017 and mailed to CFFC.
NAME OF SCHOLARSHIP: Frank L. Muzika Catholic War Veterans Memorial Scholarship
- Candidate must be a Uniontown Area High School senior and be a relative of a Catholic War Veteran.
NAME OF RELATIVE OF THE CATHOLIC WAR VETERANSOR AUXILIARY OF FR. THOMAS J. DUNN POST #1669 OF UNIONTOWN:______
STUDENT INFORMATION
NAME: ______
(Prefix)(First)(MI)(Last)
ADDRESS: ______
(Street Address – No P.O. Box)(City) (ST) (ZIP)
HOME PHONE: ______ALTERNATE OR CELL PHONE: ______
E-MAIL ADDRESS: ______BIRTHDATE: ____/_____/_____
EDUCATION (Official Transcript must be attached)
What is your Cumulative GPA? _____SAT Score: TOTAL Math/Reading/Writing: ______ACT Score: ______
High School Address: ______
(Street) (City) (ST) (ZIP)
Estimated Graduation Date: ______
This Fall, I plan to attend the following post-secondary school: ______
Address: ______
(Street) (City) (ST) (ZIP)
What will be your Major/Field of Study? ______
ACTIVITIES
Within the last four years, I’ve been a member of the following Club(s)/Committee(s): ____________
______
______
Special Awards, Honors or Other Information: ____________
______
______
Within the last four years, I’ve participated in the following sports: ______
______
______
WORK EXPERIENCE
Name of Employer: ______Type of Work: ______
Start – End Dates: ______Approximately how many hours do you work each month? ______
Name of Employer: ______Type of Work: ______
Start – End Dates: ______Approximately how many hours do you work each month? ______
VOLUNTEER EXPERIENCE
Organization: ______Type of Work: ______
Start – End Dates: ______Approximately How Many Hours do you volunteer each month? _____
Organization: ______Type of Work: ______
Start – End Dates: ______Approximately How Many Hours do you volunteer each month? _____
PARENT INFORMATION
Father: ______Mother: ______
Address: ______Address: ______
______
Phone Number: ______Phone Number: ______
Employer: ______Employer: ______
Job Title: ______Job Title: ______
How many siblings do you have? ______Including yourself, how many will be attending college in the Fall? ______
REQUIRED DOCUMENTS
IF THESE DOCUMENTS ARE NOT ATTACHED,
YOUR APPLICATION WILL NOT BE ACCEPTED
- A copy of your most recent OFFICIAL transcript.
- One letter of reference (parents and immediate family members are NOT eligible as a reference.)
- A 300-500 word essay on the following: What is something you’ve changed your mind about in the last three years? What motivated you to make that decision?
CONSENT & VERIFICATION
In submitting this application, I certify that the information provided in this application is complete and accurate to the best of my knowledge. I understand that all decisions made by the CFFC Scholarship Committee(s) are final and not subject to review or appeal. I further understand that any information provided in this form may be shared with committee members and donors of the sponsoring scholarships. Also, I understand that falsification of information may result in termination of any scholarship granted. If selected to receive a scholarship, I agree to the use of my name, likeness, and information contained in my application (excluding any financial information) for promotional purposes for the Community Foundation of Fayette County, without further compensation or notification.
Student’s Signature: ______Date: ______
Printed Name: ______
Parent’s Signature: ______Date: ______
(If student is under 18 years of age)
Printed Name: ______
If you are selected to receive an award, you will be notified in May.