9320LakesideBlvd,Bldg.2,Suite200 (281)363-8158

TheWoodlands,TX77381 Fax:(281)363-8191

APPLICATION

for the

Montgomery County Community Foundation

Henry and Billie Brooks Scholarship

At Lone Star College-Montgomery

The Henry and Billie Brooks Scholarship Fund at Montgomery County Community Foundation was created to benefit need-based students from Montgomery County planning to attend Lone Star College-Montgomery as full time students. This endowed scholarship fund was created in November of 2007 by the Brooks out of their commitment to the importance of higher education and the residents of Montgomery County.

Applicants wishing to be considered for the Henry and Billie Brooks Scholarship must be United States Citizens, reside in Montgomery County, Texas, and intend to enroll as full time students at Lone Star College-Montgomery.

Selected recipients will be elgible to receive this $1,000 scholarship for 4 consecutive semesters during a 2 year period, provided that he/she successfully completes a minimum of 9 semester hours and maintains at least a B grade point average each semester. To continue the scholarship past the initial semester, it is the recipients responsibility to request that Lone Star College-Montgomery mail an “official transcript” directly to Montgomery County Community Foundation at the conclusion of each semester showing evidence of the above requirements.

APPLICATOIN DISTRIBUTION:Financial Aid Office of LSC-M and each participating high school Senior Counselor’s Office

DEADLINE: March 10, 2017 by 5:00 p. m. to the Financial Aid Office of Lone Star College-Montgomery; Attn: MCCF Henry & Billie Brooks Scholarship.

THE MCCF HENRY AND BILLIE BROOKS SCHOLARSHIP

AT LONE STAR COLLEGE-MONTGOMARY

SCHOLARSHIP APPLICATION

Please print or type.

______

Last NameFirst NameMiddle Name Social Security Number

Date of Birth: ______Countries of citizenship (required) : ______

Month DayYear

Address ______

Street City State Zip

______

Home Phone Number Mobile Number

Student e-mail address______Parent e-mail address ______

Probable major: ______First semester to be enrolled:______

High school attended: ______Graduation date:______

Month Day Year

Father’s occupation and employer:______

Mother’s occupation and employer:______

Family taxable income after deductions:______Number of children in family______Pre-school_____K-12_____College______

Attach the first two pages of your family’s IRS Form 1040 (private information can be blacked out) to verify taxable income.

Attach a copy of your latest high school transcript.

On a separate typed sheet, list significant activities, honors, scholarships and awards received during your high school years in order of importance to you. NOTE: If you have more than ten, list the most important including information on:

Honor/ScholarshipSponsorBasis forAward Date Received

Required supplemental typed essay:

In one page or less, write an essay on “How an Associate’s Degree From LSC-Montgomery Could Change My Life”.

______

Certification:

I hereby certify that the above information is true and accurate to the best of my knowledge. Further, I authorize representatives of Montgomery County Community Foundation to release my name and/or photograph to the local news media in publications relating to the Henry and Billie Brooks Scholarship at Lone Star College-Montgomery.

______

Signature of Applicant DateSignature of Parent/Guardian (required) Date

*Appliction and attachments must be complete to be considered.