FIRST NATIONAL BANK & TRUST COMPANY OF ARDMORE
SCHOLARSHIP APPLICATION
I,______, will graduate this spring from
______and plan to continue my education in college starting with the fall of 2015. If I am chosen as a recipient of this program, I understand that in order to accept this award, I must attend a two or four year accredited college in the United States approved by First National Bank.
STUDENT’S HOME ADDRESS:
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Street City State Zip Code
Telephone Number______Social Security Number______
HIGH SCHOOL ADDRESS:
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P.O. Box or Street City State Zip Code
COLLEGE CHOICE:
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P.O. Box or Street City State Zip Code
How many years do you plan to attend college?______
What is your field of study? ______
Counselor’s Name:______Phone Number:______
Date:______Applicant’s Signature:______
FIRST NATIONAL BANK & TRUST COMPANY SCHOLARSHIP PROGRAM
OBJECTIVE CRITERIA LIST
Parts I, II and III of this form are to be completed by the applicant’s principal or counselor. Parts IV-VIII to be completed by the applicant. Both pages, along with the application form, must be returned by April 15, 2015 to:
First National Bank and Trust Company of Ardmore,
Attn: Ryan Youderian, Scholarship Chairman
P.O. Box 69, Ardmore, OK 73402
I. College entrance examination score (ACT or SAT)
Please circle the type of examination taken.
ACT composite score OR
SAT combined score ______
II. Student’s cumulative high school
grade point average (GPA)
excluding spring semester of senior year. ______
III. Please list student’s classes for terms indicated:
Junior YearGradeSenior Year Grade*
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*Grades may be omitted on second semester of senior year.
Honors Junior Year:______
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Honors Senior Year:______
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Student’s Name:______
Counselor’s or Principle’s Signature:______Date:______
IV. Financial Need - In the space provided please indicate your family’s adjusted gross income from last year’s tax return.
_____under $15,000_____$30,000 to $35,000
_____$15,000 to $20,000_____$35,000 to $40,000
_____$20,000 to $25,000_____$40,000 to $50,000
_____$25,000 to $30,000_____over $50,000
Total number of family members living at home:______
Number of dependants in your parents’ family including yourself:
Children:______Ages:______Number attending college:______
Other financial considerations which need to be noted:______
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V. Extracurricular Activities - Organizations and clubs (Indicate years of involvement, offices held, etc.):
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Honors and Awards: ______
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Community or Other Activities: ______
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VI. Work Activities - Are you now employed? Yes ______No______
If yes, what type of work and how many hour per week?
______
______
Do you plan on working while you attend college? Yes ______No ______
Do you plan to live on campus or commute? ______
VII. Are you a related to any current First National Bank & Trust employee; if so how? Yes / No
VIII. Do you or your parents have any active accounts with First National Bank & Trust (loans, checking, etc…)? Yes / No
In the space provided below, please describe in 100 words or less (in your own words and handwriting) why you want to be a recipient of the First National Bank Scholarship Fund, the course of study or major field of interest you plan to follow, your proposed occupation or profession, and any other abilities you have that were not previously mentioned in this form.
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Student’s Signature