AGNES PEEBLES MEMORIAL SCHOLARSHIP APPLICATION
(FEMALES ONLY)
IRCDSB MUST RECEIVE BY March 15th
Send application directly by email: .
Apply only if you are going to attend a four-year University in the state of Florida. This scholarship is restricted to Florida state “public” universities. Colleges (IRSC), community colleges, and private colleges are excluded.
Please print:
Student’s Name: Home No.:
Address: ______City:______Zip Code______
Cell No.: ______University ID: ______
E-mail Address: ______
Father’s Name: ______Occupation: ______
Mother’s Name: Occupation:
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Resides with: Both Parents: , Father: , Mother: , Other:
Parents: Own Home: , Mortgage: , Rent: , Other:
No. of people living at home: , Other siblings in college?
Automobiles in family - Year and Make:
Do you work? Where?
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Have you applied for other college financial aid?
If so, Source of Aid: Approved: Amount:
Source of Aid: Approved: Amount:
Source of Aid: Approved: Amount:
Are you eligible for an academic scholarship?
Years enrolled IRC Schools: Virtual: IRSC: Home:
Class Rank: SAT Score: ACT Score: Other:
School activities and special projects (band, yearbook, clubs, sports, volunteer work):
Four-Year Universities in Florida only:
University of Choice: Accepted:
2nd Choice: Accepted:
Field of Study:
Occupational Goal:
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Parent’s/Student’s Statement:
To the best of my knowledge and belief the statements and figures contained herein are complete and accurate.
Student’s Signature Parent’s Signature
Attached is a copy of my parents’ (mother’s and father’s) most recent Income Tax form and my income tax form that shows proof of income. Also ensure that you attach a Counselor form.
A written Trust Agreement was established in 1953 by Mrs. Agnes Peebles.
The purpose of this scholarship is for a female graduate of a high school in Indian River County to attend a four-year university under the supervision of the Florida Department of Education. The student does not have to be a recent graduate but must be a graduate of a high school in Indian River County (public or private). The selection is based on financial need, plus the firm desire for a university education. The student does not have to be an “A” student or the President of her Class. Scholarship amounts will vary depending on available funds. Note: This scholarship will continue every year for a four-year bachelor’s degree program as long as the student maintains “C” grades in each class at the university and is enrolled as a full-time student.