Scholarship Application for High School Seniors

Personal Information Date: ______

Name: ______

Address: ______

City______Zip______County______

You must be a resident of Wake, Durham or Orange County to receive aid.

U.S. Citizen: YES _____ NO _____ Permanent Resident: YES _____ N0______

Please submit proof of permanent resident status if you are not a U. S. citizen.

Home Phone: ______Cell Phone:______

Email: ______@______

High School Attending: ______Anticipated Graduation Date : ______

Weighted GPA: ______Unweighted GPA:______Class Rank: ______of_____

SAT Scores: Math______Writing ______Critical Reading______

ACT Scores: Math ___ Science____ Reading _____English ______Composite ____

______

Name of Father/Guardian Occupation Employer

______

Name of Mother/Guardian Occupation Employer

List ages of dependent children in the household including yourself: ______none_____

Finances

Total 2017Household Income: ______Student income: ______

If you are using a FAFSA with 2016 income, how has your income changed in 2017?

This is a needs based scholarship. Provide a description of your financial need:

Educational Plans : you must attend a North Carolina institution to receive aid.

Please list the educational institutions to which you are applying in order of your preference.

1.

2.

3.

4.

5.

What are your career goals? What field of study do you plan to pursue and why?

When do you plan to start/continue your education? Summer or Fall? If other tell us why.

Personal Experiences: List high school experiences in the order of importance to you.

List community service, volunteer activities or internships:

ActivityHoursDatesPosition Held

List extracurricular activities during high school:

ActivityHoursDatesPosition Held

List paid work experiences and number of hours employed:

EmployerHoursDatesPosition Held

List awards or honors received during high school:

Personal Statement (optional): Is there anything else you would like the scholarship selection committee to know about you or your family?

Essay

In order to help the Assistance League scholarship selection committee choose the winners of this year’s grants, write a 300 to 500-word essay on one of the topics that best reveals your life experiences and goals. A hand written or word-processed essay will be accepted.

Topic 1: What is your favorite song, poem, word or quotation and why?

Topic 2:Identify a personal experience you had that changed how you thought about something. What did you learn from the experience?

Assistance League of the Triangle Area reserves the right to award scholarships all in one category or separately in each or some of the categories annually.

______

Student Signature Date

Check your application to make sure the following are included:
  • High School transcripts verifying GPA and Class Rank through first semester of senior year
  • Proof of permanent residency if not a citizen
  • A complete copy of FAFSA/SAR Form showing income, number of dependents
  • Two letters of references:
- One signed reference from a teacher in your high school on school letterhead
- One signed reference from someone outside your family who knows you personally -
a minister, scout leader, coach, employer, another teacher etc.
  • Essay – please follow instructions above
Incomplete or Late Applications Will Be Disqualified
Applications must be completed no later than
March 1, 2018*
Questions to
Scholarship Phone (919) 438-1682
Email:
Mail any correspondence to
ASSISTANCE LEAGUETriangle Area
Scholarship Committee
P. O. Box 98477
Raleigh, NC 27624
*If you are mailing on March 1 go into the post office and have the clerk hand cancel your envelope. If you drop it in a box, it will be postmarked on March 2 and will be disqualified.