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BEAUMONT FOUNDATION

A NONPROFIT CORPORATION

Scholarship Application

Low Family Monsignor Kelly High School Scholarship

TheLowFamily Monsignor Kelly High School Scholarship Program was created to increase access to higher education for students from Monsignor Kelly High School. The scholarship programprovides funding for tuition, fees, books and supplies (up to $12,500 per year) for one student annually to attend a Texas supported public University/College.

PLEASE PRINT OR TYPE

  1. STUDENT INFORMATION

Name:______Gender ______

Last, First, Middle initial (M/F)

Social Security Number:______Birth Date:______

Month/Day/Year

Permanent Address:______

Street

______

City/State/Zip

Home Phone Number:______Cell Number: ______

Email Address:______

DEPENDENT STUDENTS:

Parent, stepparent or guardian A: ______

Name Age State of legal residence

Parent, stepparent or guardian B: ______

Name Age State of legal residence

B. ENTRANCE PROFILE

Please attach an official copy of your high school transcript.

Current High School GPA: ______Class Rank: ____ out of ____ students

Test Scores:

SAT: Math: ______Verbal: ______and/or ACT: Composite:______

University/College attending: ______

Why did you select this university/college?

______

______

Are you: Accepted/Awaiting a decision (circle one)

Future Enrollment status: Full-time/Part-time (circle one)

Housing status while attending college: On campus/Off campus/At home with family (circle one)

Intended field of study: ______

Degree sought: ______

C. STUDENT ACTIVITIES

Please attach a list of academic, civic and social activities in which you participate, including positions held, dates of participation, estimated time spent on each activity and any special honors received.

D. ESSAY

Please submit an essay about what it meansto you to receive a Rachael Low Roane Monsignor Kelly High SchoolScholarship from the Beaumont Foundation of America? (300 word limit, double spaced, typed)

E. LETTERS OF RECOMMENDATION

Please attach two (2) letters of recommendation from individuals who can help to help to present an accurate and complete picture of you and your qualifications, including academic achievement, leadership abilities, volunteer commitments, extracurricular activities, and personal interests. One letter must be from a high school teacher.

F. FINANCIAL AID INFORMATION

  1. Please attach a copy of your FAFSA Student Aid Report (SAR) from the U. S. Dept. of Education. This is the returned report you received after submitting theFAFSA Application Form. (Beaumont Foundation of America applications thatdo not contain this document will not be considered by the selection committee.)
  1. Have you applied or do you expect to apply for scholarship aid from sources other than the Beaumont Foundation of America? ______If so, please indicate the circumstances ______

______

  1. ADDITIONAL INFORMATION

Special circumstances: Do you have any unusual personal, financial or family circumstances that warrant special attention by the selection committee? Please be specific. (You may add one additional page, 300 word limit.)

  1. Will you be the first person in your family to attend college?

___ Yes ____No

  1. How did you hear about this award?

______

______

  1. CERTIFICATION AND SIGNATURES

I certify that the information on this form, together with information contained in any sheets attached, is true and complete to the best of my knowledge. If asked by any authorized official of the Beaumont Foundation, I agree to give documentation for information given on this form. I realize that failure to comply with a request for additional information may prevent the applicant from receiving any aid. I agree to participate in any interviews that may be conducted by the Beaumont Foundation prior to selection of scholarship recipients. I also grant permission to the Beaumont Foundation to use my photograph and/or selected quotes on their website and in future publications.By signing this application, I hereby give my permission and authorize Beaumont Foundation to verify my personal information with my current school and respective college. Failure to provide accurate information will be grounds for disqualification.

______/______

Applicant’s signature date

______/______

Parent’s signature (is applicant is dependent) date

Send completed application and all required attachments together in ONE ENVELOPE by the due date specified to:

Development Director

Monsignor Kelly Catholic High School

5950 Kelly Drive

Beaumont, TX 77707

(409) 866-2351

  • Please do not staple application or attachments together.
  • Financial information is confidential for review only by members of the Grant Selection Committee and the Beaumont Foundation.