Applicants must be of Iranian descent, lawfully reside in the United Sates, and attend an accredited American college or university in a degreed program. Application materials must be mailed in one packet to Omid Behbahani Scholarship Program, 11 Beaufort Hunt LN, Cincinnati, OH 45242. Transcripts and letters of recommendation should not be sent under separate cover. Incomplete, e-mailed or faxed applications will not be considered.
I am submitting my application by 15-June-2017 to be considered for the 2017 Omid Behbahani Scholarship Program.
PERSONAL DATA
(All information must be filled out)
Full Legal Name ______
Last First Middle Male/Female
Permanent Address ______
Street
______
City State Zip
______
Date of Birth Phone Number Email Address
Social Security Number______-______-______(if awarded, for tax purposes)
Are you a US Citizen? Yes No If no, what is your legal status? ______
COLLEGE / UNIVERSITY INFORMATION
Name ______
Address ______
Contact: ______
Name Address Phone
Major ______# of college/University Credits Competed ______
Cumulative GPA ______
If you are a freshman in fall 2017, what is your unweighted high school GPA ______
Omid Behbahani Scholarship Program Application Form (PAGE 2)Please respond to the following questions. Attach your typed responses to this form.
Resume- List your extracurricular activities, community service, employment, awards and honors you have received for academic or extracurricular achievements. Indicate the dates you participated in the activity, positions held and the number of hours per week youspend on each.
Essay- One essay in English is required. Your essay should be succinct, no longer than one page single spaced, and addressesthe following topics:
a. Tell us about yourself.
b.Choose the one activity you listed in your resume and tell us why it is significant to you.
c. Explain your financial need. Include any state or federal financial aids that you qualify for.
d. Why should you be rewarded this scholarship?
e. Personal Goals
Recommendations: Two recommendations are required. One recommendation must be from College/University academic professional, with knowledge of your academic and school based activities.
Financial Need- Submit a copy of Student Aid Report (SAR) or 2015 Tax Return of the student and parents (if applicable) to show eligibility for financial assistance. Please include any other documentation showing assistance you receive from your college or university.
Transcript- Submit an official and most current transcript showing college/university seal.
You must be ready to provide supporting documentation if requested.
TO BE COMPLETED BY PARENT OR GUARDIAN IF THE APPLICANT IS LESS THAN 18 YEARS OF AGE
Father/Male Guardian Mother/Female Guardian
______
Name Name
______
Address Address
______
Occupation Occupation
______
2015 Adjusted Gross Income (IRS 1040) 2015 Adjusted Gross Income (IRS 1040)
______
Estimated Adjusted Gross Income (2016) Estimated Adjusted Gross Income (2016)
Are you being claimed as dependent on your parents/guardians tax returns? Yes No
Parent’s marital status: Single Married Separated Divorced Widowed
If applicable, please indicate with whom you reside:______
Ages of applicant’s siblings (if applicable) ______# of siblings attending college next year ______
We certify that the information provided is true and complete to the best of our knowledge. Applicants may be asked to provide information about the non-custodial parent or step-parent financial contributions. If required, we agree to provide proof of this information, including copies of income tax returns. We realize that if documentation is not provided, the applicant may be deemed ineligible for this scholarship.
______
Applicant’s Signature/Date Parent or Guardian’s Signature/Date