Brooksville Education Foundation

Scholarship Application

GENERAL INFORMATION

Student's Name: ______

Social Security #: ______

Date of birth:______

Address: ______

Phone: ______

Fax/email:______

Father's Name: ______

Occupation:______

Mother's Name: ______

Occupation:______

Names and ages of brothers and sisters: Attending College? Yes No

______

______

______

______

Your Occupation (if applicable): ______

If married, Spouse's Name: ______

Occupation:______

Children's names and ages: Attending College? Yes - No

______

______

______

______

Permanent, year-round resident of Brooksville? Yes ___ since ______No___

Are you in the first generation of your immediate family to attend college? Yes_____ No____

EDUCATION, WORK EXPERIENCE, COMMUNITY ACTIVITIES

Name of institution in which you are currently enrolled:

______

Address and phone number of institution (main number):

______

______

Year of schooling completed (circle one) :

High School: 9 10 11 12

College:1 2 3 4

Graduate School:1 2 3 4

Cumulative GPA: ______Class Standing: ______out of ______

SAT Scores (optional): Verbal______Math______

School activities: (for example: dramatics, band, chess club, sports; honors, class offices) and years participating:

______

______

______

Please include a copy of your educational transcript.

Please have reference letters sent to us by two people not related to you, such as teachers, coaches, or employers. Please supply the names, addresses, and phone numbers of the people you have asked for references:

1)______

______

2)______

______

Please describe your work experience, including positions held, period of employment, and hours worked/week:

______

______

______

______

______

Please describe community activities you have been involved with, including approximate dates:

______

______

______

______

______

Are there significant accomplishments in your educational or personal background that are not reflected in the above record? Please explain:

______

______

______

______

Name and address of the school where your scholarship will be used: Please include the telephone number of Financial Aid Office:

______

______

______

Proposed major area of study or present interest:

______

Length of Program (circle one) 1 2 3 4 years.Degree anticipated:

______

FINANCIAL

Please enclose:

•Financial Aid Award Letter from the school you plan to attend(send with this application or as soon as available thereafter)

•Amounts of Other Sources of Aid Available to You, such as scholarships awarded by your high school, or gifts from relatives other than parents.

Please list the annual costs of the school you plan to attend:

Tuition
Room
Board
Books
Lab fees/equipment
Transportation
Other (explain)
Total

Briefly explain any significant or unusual personal or family circumstances not covered by any of the above, that you feel might contribute to your consideration as a scholarship applicant:

______

______

______
______

OTHER

Briefly explain what difference a BEF grant will make in your schooling plans (For example: Influencing a decision/ability to go to college; one college versus another; four versus two year program; summer work in field of study):

______

______

______

______

Please attach a personal statement (500 words or less) describing your aspirations and how your educational plans relate to them.

Submitted By: ______

Signature of Applicant

Mail Completed Application To:

Brooksville Education Foundation
P.O. Box 277
Brooksville, ME 04617

Be sure to include your educational transcript, Student Aid Report cover sheet, and Financial Aid Award Letter.

1