2012 Fil-Am Association of the Triad, NC, U. S.A. Foundation

Student Aid Program

High School Senior

Please TYPE OR PRINT ALL INFORMATION

APPLICANTLast Name ______First ______Middle Initial _____

Permanent Home

Mailing Address______Apartment # ______

City______State _____ Zip/Postal Code ______

Telephone (____) ______E-mail Address ______

Date of Birth: Month ______Day _____ Year ______

PARENT ORLast Name ______First ______Middle Initial ______

GUARDIANMailing Address ______Apartment # ______

INFORMATION(if different from applicant)

City______State _____ Zip/Postal Code ______

Relationship to Applicant ______

HIGHSchool Name ______Dates of Attendance: From ______To ______

SCHOOLCity______State _____ Telephone (____) ______

DATADiploma or Certificate Awarded ______GPA ______

Graduation Date: Month ______Day ___ Year ______

POST-Name of college, university or other post secondary school you plan to attend next

SECONDARYacademic year ______

SCHOOLAddress ______

DATACityState Zip Code

___College or University (4 years) ___ Community or Junior College (2 years)

Intended Major ______Length of Program: Months ____ Years ____

ACTIVITIES,List all extracurricular activities (in and outside of school) in which you have participated in

AWARDS ANDduring the past four years (e.g. student government, music, sports, clubs, volunteer work,

HONORSScouts, etc.). Indicate all special awards, honors and offices held.

ActivityNo. years participatedAwardsOffice

GOALS Make a brief statement of your plans as they relate to your education, career objectives and

ANDlong term goals.

ASPIRATIONS

The student is responsible for submitting all materials to Fil-Am Association of the Triad (FAAT) Educational Program Committee (EPC) in a timely manner. Once submitted this application and all materials then becomes the property of the E.P.C.

CERTIFICATIONI acknowledge that the decisions of the E.P.C. of F.A.A.T. are final. I further certify that I met the basic eligibility requirements of the program as described and that the information provided is complete and accurate to the best of my knowledge. If so requested I agree to provide proof of any information that I have submitted on this form. Falsification of any information may result in repayment of any financial aid granted.

Applicant’s Signature Date

Parent’s Signature Date