Tri Counties Bank

Scholarship Requirements and Application

Applicant Must:

  1. Be a senior graduating with the current graduating class.
  2. Have maintained a minimum 2.5 GPA in their senior year.
  3. Plan to register as a full-time college student within the 12 months following date of graduation (proof of enrollment must be provided to Bank before funds are distributed).
  4. FULLY complete and submit the attached scholarship application by 04:00 p.m. on Friday, April 24th 2015 (partial or incomplete applications, or applications lacking all attachments will not be considered).

(Application must be typed and ALL items completed. Failure to complete an item will result in disqualification from applicant pool. All information is for the sole use of the Scholarship Selection Committee and will be considered confidential.)

PERSONAL INFORMATION

  1. Name:
  2. Mailing Address:
  3. Physical Address (if different):
    (This information is used for internal tracking purposes only):
  4. Telephone:
  5. Age:

CURRENT SCHOOL INFORMATION

  1. High school attending:
  2. Weighted GPA (Cumulative):

Non-Weighted GPA (Cumulative):

Fall 2014 Senior GPA:

BANKING RELATIONSHIP INFORMATION

  1. Do you have any relatives that work at Tri Counties Bank? List names and relationships to you?
  2. Do you or does anyone in your immediate family bank with Tri Counties Bank? List names and relationships to you. (Not a requirement but may give preference in the case of a tie.)

(Immediate family includes mother/father/sibling/grandparent/guardian)

COLLEGE OR VOCATIONAL SCHOOL INFORMATION

  1. Name of college or vocational school you will attend, or those you are considering and city/state located:
  2. Have you been accepted?
  3. What is your proposed objective (major, degree, credential, etc. “Undecided” is acceptable, but please list interests:

EMPLOYMENT AND VOLUNTEER HISTORY

  1. List current and prior 2 years paid employments. Attach additional page if necessary.

Employer Name

/

Type of work performed

/

Dates of employment

/ Approx. Hours/week / Hourly pay
  1. List current and prior 2 years volunteerism. Attach additional page if necessary.

Organization Name

/

Type of work performed

/

Dates of volunteerism

/ Hours volunteered

FINANCIAL NEED

  1. Do you intend to work while attending college? Explain:
  2. Please briefly describe your living situation (i.e., single or two parent home, or guardian (include relationship to guardian), or if you live alone, have children, etc.).
  3. List Parents/Guardian living with you:

Relationship to you: Occupation:

Relationship to you: Occupation:

  1. Please list last approximate annual gross household income and briefly describe your family’s financial situation. Describe sources of income including child support, disability/Social Security, unemployment, etc., and list any special or financial needs or circumstances that will help us understand your situation.
  2. List other members of the immediate family DEPENDANT upon parent or guardian. List age, relationship and if in college, note where: Attach additional page if necessary.
  3. List other scholarships/grants you have received or applied for (note if received):

Scholarship/grant

/

Amount applied for

/

Amount awarded (if known)

REQUIRED ATTACHMENTS:

1.ATTACH an essay on “I wish to be considered for a scholarship because…”. Include things such as your financial circumstances, how you plan to use the scholarship for your future education, your goals, and any additional information you believe to be material. Please keep it to one page or less.

2.ATTACH one letter of recommendation from an acquaintance, employer or teacher.

3.ATTACH a copy of complete, current transcript for the most recent semester.

4.ATTACH the cover page of your family’s most recent Tax Return. Please cover or redact Social Security Numbers.

By checking this box, I hereby attest that to the best of my knowledge, all the information above is true and complete.

______

Student SignatureDate

______

Parent/Guardian SignatureDate

APPLICATION SUBMISSION INSTRUCTIONS:

Scholarship Applications may be sent via email, mail, or walk-in to:

United Way of Northern California

Attn: Scholarship Committee

2280 Benton Drive, Box 14, Building B

Redding, CA 96003

530-241-7521

DEADLINE for 2015 Grads: Mail in applications must be postmarked by April 24th, 2015. Walk-ins must be received by 4:00pm on April 24th.