Helen Biery Memorial Scholarship

Helen Biery Memorial Scholarship

For students who have graduated from an Ohio County high school. The recipient must enroll in an accredited program providing education and training in nursing and/or related medical care profession. Award is $500.

Application Checklist

Application Deadline: March 1, 2017

CHECKLIST

Application Guidelines – Carefully read this page to ensure your application form and other forms are complete and accurate.

Letter of Recommendation – Ask evaluator to complete form and return to you in a sealed envelope with evaluator’s signature. Include the recommendation with all other application materials. Parents, immediate family members or school counselors are NOT eligible to write the letter of recommendation.

Activities Form – Please use the included form to provide information on Extracurricular Activities, Awards and Honors, Community and Volunteer Activities, and Work Experience.

Financial Form – Please provide up-to-date information utilizing all financial data as applicable from FAFSA and college financial aid awards.

Grade Certification Form – Have appropriate school official complete form and return it with other application materials.

Official Transcripts–Request transcripts that include grades from the most recently completed grading period and return with other application materials.

Personal Essay – Please attach a personal essay.

Mailing Address/Office Location:

CFOV

1310 Market Street

Wheeling, WV 26003

Application: Helen Biery Memorial Scholarship

PERSONAL INFORMATION

Name: ______

Permanent Address: ______

Street or PO BoxCityStateZip

What county do you live in? ______U.S. Resident?  yes no

Date of Birth: ______/______/______

Telephone:Day (______) ______-______Evening (______) ______-______

Email: ______

Father’s Name: ______Occupation: ______

Mother’s Name: ______Occupation: ______

ACADEMIC INFORMATION

Name of high school: ______

Name of school counselor: ______

High School Phone Number: (______) ______-______Cumulative GPA: ______

If diploma attained via GED, indicate City/State and date obtained: ______

UNIVERSITY INFORMATION

Name of college/university in which you plan to enroll or are currently enrolled:

______

NameCityState

Have you been accepted?  yes no

Include a copy of the letter from the school acknowledging receipt of your application or offering you enrollment

Will you be full-time (12 or more credit hours) this fall?  yes no

Anticipated major or area of study: ______

List the dates (month/year) you expect to begin and complete your degree:

Begin: ______Complete: ______

GPA (if currently enrolled) ______

Do you plan to live:  on campus  off campus  commute from home  unknown

Do you meet the eligibility criteria for the WV Promise Scholarship? yes  no

LETTER OF RECOMMENDATION

Signed and sealed letter must accompany this application.

Name: ______

Relationship: ______

When selecting someone to complete your recommendation, select someone who will be thorough in the review of your character. Select someone who knows you (and your family) well and will be able to give a candid and unbiased evaluation. Your recommendation must be completed by someone other than your parents, immediate family or school counselors. In the past, ministers, coaches, employers, supervisors, neighbors, teachers, or a friend of the family has written recommendations.

The evaluator should also provide a brief statement as to why he or she thinks you are most deserving of the scholarship.

Personal Essay

On a separate sheet of paper, please take the time to prepare a well-developed, well-written, grammatically correct personal essay. The essay is to be limited to one typed page. Spelling and grammar do matter!

This is your opportunity for the Selection Committee to get to know you as an individual.

You may want to write about an interest you have, a challenge you have overcome, or something that you are passionate about. The objective is to give you a chance to tell us about another dimension of you not previously revealed. There is no “correct” way to develop and prepare this essay. In writing about something that matters to you, you will convey a sense of yourself that will provide invaluable information during the evaluation process.

I, the student, completed this application and certify that all information contained within is correct and true to the best of my knowledge.

Signature ______Date ______

Letter of Recommendation Form

Application Deadline: March 1,2017

To Evaluator: The applicant is applying for a scholarship with the Community Foundation for the Ohio Valley, Inc. Your evaluation is needed as part of the application process. The student has authorized you to release any information you feel would be helpful in reviewing his/her application. Your cooperation in providing this information is important to the selection of award recipients. To insure confidentiality, please return this form to the student in a sealed envelope with your signature across the seal. In the space provided below, please make a statement describing the applicant’s character, school, and community leadership abilities, potential to succeed, and evidence of the student’s strengths and weaknesses, not to exceed one page in length. If you are using your letterhead, be sure to include this form in addition to your recommendation.

I am writing this evaluation on the behalf of ______

Evaluator’s Name: ______

Telephone Number: (______) ______-______

Relationship to applicant: ______

How long have you known the applicant? ______

An evaluation received with a broken seal will be rejected. Please be sure to seal and sign the envelope and return to applicant in order that it may be included along with the application packet. Remember – parents, immediate family members and school counselors are not eligible to write the evaluation.

Activities Form

Please list extracurricular, community and personal activities in which you have participated during the past three years as well as activities you are planning for the current year. Include clubs, debate, school sports, student government, fine arts, volunteer work, youth programs, athletic programs, music, scouting, etc. Please do not use acronyms.

Extracurricular Activities / Year / Position Held
Fr / So / Jr / Sr
Community/Volunteer Activities / Year / Position Held
Fr / So / Jr / Sr
Awards and Honors / Year / Comments
Fr / So / Jr / Sr
Work Experience / Dates of Employment / Position Held

Financial Form

If you are a dependent applicant, please have your parents complete this form using information from their 2015 Federal Income Tax Return.
If you are an independent applicant you do not need to supply parental information. You (and spouse, if applicable) will also use information from your 2015 Federal Tax Return.
Documentation:
Please include the page of the FAFSA Student Aid Report that provides your Expected Family Contribution.
DO NOT include copies of tax returns. The information you provide should be taken from the return.
We will notify you if the selection committee requests additional detail pertaining to the reported figures. Providing fraudulent information will result in revocation of any awarded scholarships and/or other related penalties.
Applicant status:

Dependent Applicant (using parental information)  Independent Applicant (using your information)

1. Adjusted Gross Income (as reported on 2015 tax return) $______

1. Annual Income Earned$______(Father)$______(Mother)

$______(Student)$______(Spouse)

Parent(s)Student

1. Untaxed income/benefits (AFDC, ADC, SSI, etc.)$______$______

Source of Benefit ______

1. Cash, Savings, Stocks, Bonds, CDs, Etc.$______$______

(exclude retirement funds, i.e. IRA)

1. Net value of real estate holdings not used as a$______$______

primary residence (market value less mortgage balance)

1. Total number in household: _____ Total number attending college in 2017-2018 school year: _____

1. Estimated Family Contribution (EFC) from FAFSA Student Aid Report: ______

Father’s Occupation ______Mother’s Occupation ______

Student’s Occupation ______Spouse’s Occupation ______

Parents’ marital status: single  married  separated  divorced  widowed

Applicants’ marital status:  single  married  separated  divorced  widowed

If you wish, you may include a supplementary financial statement explaining circumstances impacting financial need that are not apparent from the above financial information. For example, contributions expected/not expected from a non-custodial parent, educational expenses of siblings, medical expenses, etc.

Expenses

Please refer to the cost of attendance budget at your first choice school. The information should be available in the institution’s publications or from the financial aid office.

Estimated Total Expenses for Coming Year

Tuition and fees:$______

Room and board: $______

Books:$______

Personal/Other Expenses:$______

Total Expenses:$______

Income

List as many items as you can estimate at this time. If you have received a financial aid notice from your first choice school, you should refer to that.

Total Income Available for Coming Year

Income from outside job:$______

Income from campus job:$______

GI or SSI Benefits:$______

Child Support:$______

Alimony:$______

Student’s Savings:$______

Parents’ Contribution:$______

Scholarships:$______
(any you’ve already been awarded)

Loans:$______

Gifts:$______

Grants:$______

Other Income:$______

Total Income:$______

Certification:

I (we) certify that all the information on this form is true and complete to the best of my (our) knowledge. If asked by an authorized official of the Community Foundation for the Ohio Valley, Inc. I (we) agree to give documentation for the information given on this form. I (we) realize that failure to comply with a request for further information may prevent the applicant from receiving aid.

Applicant’s Signature ______Parent or spouse Signature ______

Grade Certification Form

This section is to be completed by an advisor/counselor. GPA information should be on a scale of 4.0 only. Only transcripts with the fall semester will be accepted. This form and transcripts must be included with the application packet.

Student’s Name:______

School:______

At the close of the most recent semester, the applicant ranked _____ in a class of ______.

At the close of the most recent semester, the applicant’s cumulative GPA was ______on a scale of 4.0.

SAT ScoresACT Scores
Verbal:______English:______

Math:______Math:______

Combined: ______Reading: ______

Science: ______

Composite:______

Person completing this form: ______

Title: ______

Signature: ______Date: ______

AN OFFICIAL TRANSCRIPT INCLUDING MOST RECENTLY COMPLETED SEMESTER

(FALL OF PREVIOUS YEAR) MUST ACCOMPANY THIS APPLICATION.

DO NOT SEND THIS INFORMATION SEPARATELY!

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