AVANELLE HUTCHINGS POWELL SCHOLARSHIP 9/13
TO BE COMPLETED BY STUDENT AND PARENTS
(Cannot be in the top 10% of your class)
Date:______
DEADLINE: January 15
PERSONAL DATA
Student’s Name______Phone#______
Home Address______
Name of Parents or Guardian______
Home Address______
Are both parents employed? Yes______No______
Father’s Occupation______
Place of Employment______
Mother’s Occupation______
Place of Employment______
Number of children in family______Number younger______
Number in college next school year including this student______
FUTURE PLANS:
I am interested in attending college beginning with the ______semester.
College choice______
Course of study (Major and minor)______
What vocational or professional field do you plan to enter?______
______
Explain why you made this choice______
______
How many years of school will you attend?______
What degree or certification will you earn upon completion?______
FINANCIAL INFORMATION:
How much will it cost you to complete a year of schooling including room and board at the college of your choice? Complete the following according to where you plan to live.
- If you live on campus (dorm) - ______- Yearly Tuition - ______
- If you live in an apartment - ______- Books and Fees - ______
- If you live at home - ______- TOTAL - ______
Have you applied for other scholarships? ______Please list any you have received or expect to receive and the amount.
______
______
How much money did you earn this summer?______
How much did you save for college?______
How much money will you receive from family funds or other sources toward your college education?______
______
(MET, Social Security, separated parent contributions, et cetera)
What percentage of funds needed for the first year of college will be available for the beginning of school this fall?______
______
Please explain:______
Parents and/or students: Please explain any circumstances in the home or family which might create a special need for financial aid:
______
______
______
What is the pre-tax adjusted gross income, combined annual income of both parents with whom you live?
Under $10,000 ______$30,000-35,000 ______$51,000-54,000 ______
$10,000-14,000 ______$35,000-39,000 ______$54,000-57,000 ______
$14,000-17,000 ______$39,000-42,000 ______$57,000-60,000 ______
$17,000-20,000 ______$42.000-45,000 ______$60,000-63,000 ______
$20,000-25,000 ______$45,000-48,000 ______$63,000-66,000 ______
$25,000-30,000 ______$48,000-51,000 ______$66,000-70,000 ______
Over $70,000 ______
How much U.S. Income Tax was paid last year?______
Is the source of income from a business?______
Farm?______
Employed by a company?______Self Employed?______
Is the income: Salary?______Or hourly paid rate?______
ESSAY:
Please write a short essay on your plans for continuing your education beyond high school and your vocational or professional goals after the completion of training. Attach to this application.
Student’s Signature ______Date______
Parent’s Signature ______Date______
*PLEASE NOTE: Student and parent signatures serve as permission to release the attached material to the scholarship selection committees.
Counselor’s Signature______Date______
Please attach a copy of your school transcript and resume.
It is the policy of the Galesburg-Augusta Community Schools that no discriminatory practices based on sex, race, religion, color,
age, national origin, disability, height, weight, or any other status covered by federal, state or local law be allowed in
providing instructional opportunities, programs, services, job placement assistance, employment or in policies governing
student conduct and attendance.
Complaints or inquiries related to discrimination should be forwarded to:
Superintendent of Schools
1076 N. 37th St.
Galesburg, MI 49053
269-484-2000
Dania Bazzi, Superintendent * 1076 N. 37th, Galesburg, MI 49053 * (269) 484-2000 * Fax (269) 484-2001