Norbert L. Gazin Education FundApplication for Scholarship

2014

Please submit the attached application to the Guidance Office

by March 21, 2014.

* NO LATE OR INCOMPLETE APPLICATIONS WILL BE CONSIDERED. It is the student's responsibility to make sure all parts of the application are in by the deadline date.

Requirements:

  1. Applicant must:
  2. Be born in LewisCountyOR parents resided in LewisCounty at the time of birth.
  3. Be a resident of LewisCounty for at least five (5) years prior to application.
  4. Be a graduate (or will be a graduate) of a LewisCountyHigh School.
  5. Have no felony convictions.
  6. Be enrolling or enrolled in a full-time college program.
  1. PRIORITY will be given to eligible applicants enrolling or enrolled in schools of:
  2. Engineering
  3. Agriculture
  4. Forestry

3. a. High School Applicants who are not declaring one of the priority majors should have a minimum of an 80 G.P.A. to apply for the Gazin Scholarship.

  1. High School Applicants who are declaring PRIORITY(engineering, agriculture, or forestry) major must have a minimum of a 70 G.P.A. to apply for the Gazin Scholarship.
  2. Alumni may apply for the Gazin Scholarship each year however; they should have a minimum of a 2.5cumulative G.P.A. and submit the most recent transcript (Fall 2012).
  3. Graduate students may apply for the Gazin Scholarship if they qualify for the priority majors only: engineering, agriculture, or forestry and have a minimum G.P.A. of 3.0.

The Gazin Scholarship is becoming more competitive each year. A minimum G.P.A. criteria has been established to apply, however, the committee reserves the right to determine winners each year to maintain the integrity of the scholarship. Winners will be notified by July 1, 2014.

*Attach to your application:

___Complete high school transcript (for high school students) or

Complete college transcript w/cumulative GPA (for college students)

___ Copy of your birth certificate (new applicants only)

___ Copy of college acceptance letter (for high school students)

(Current college students who are submitting college transcripts DO NOT have to attach acceptance letter.)

NORBERT L. GAZIN EDUCATIONAL FUND SCHOLARSHIP APPLICATION

2014

Information to be completed by STUDENT (Please Print or Type)

Student’s Name:High School

Address: ______

DOB: _Social Security #: Telephone #:

Cumulative G.P.A. ______Date of High School Graduation______

Have you ever been convicted of a felony? Yes _____No_____(If yes, you are not eligible.)

Were your parents residing in LewisCounty at the time of your birth? Yes _____ No ______(If no, you are not eligible.)

Have you resided in LewisCounty for at least five (5) years? Yes_____ No ______(If no, you are not eligible.)

College/Training

Name of college/trade school you expect to attend

Address:______City: ______State: ______Zip: ______

Have you been accepted? Yes _____ No _____ (if yes, attach copy of acceptance letter)

Major course of study/trade

Anticipated date of program completion______Full-Time _____(If not full time, you are not eligible.)

Alumni Only:

Have you previously received this award? Yes _____ No _____

If so, please state the date(s) of award: ______

Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved.

Student’s SignatureDate

WORK EXPERIENCE: (Part-time, full-time or vacation, paid or volunteer)

Employer

/

Employer’s Address

/

Title

/

Start Date

/

End Date

SCHOOL & EXTRACURRICULAR ACTIVITIES:

List all school organizations, major activities, honors and offices held.

List out-of-school organizations, memberships and offices held.

List hobbies, recreation and sport activities.

STUDENT PARAGRAPH

Please type and attach or neatly hand write a paragraph

on your anticipated career and why you have chosen it.

Information to be completed PARENT (Please print or Type)

Information regarding applicant’s family:

Father, Stepfather, Guardian (circle one) Mother, Stepmother, Guardian (circle one)

NameName

AddressAddress

List brothers and sisters in household, including names, ages and year in school.