SHS PTA SCHOLARSHIP FUND for CollegeAPPLICATION

All information is confidential – print this form and mail in as directed below

STUDENT'S NAME______HOMEPHONE______

ADDRESS______E-MAIL______

STUDENT’S CELL PHONE: ______DEAN______

THE FOLLOWING MATERIALS MUST BE SUBMITTED WITH YOUR APPLICATION. Incomplete applications will NOT be considered.

□ Acceptance letter from the college you plan to attend

□ Application form

□ Student Statement (typed)

□ Anticipated Costs Worksheet (include copy of the web page from your college outlining college expenses)

□ Copy of FAFSA (Free Application for Federal Student Aid, available from You must

complete the FAFSA form even if you did not submit one in connection with your college application .

□ Copies of most recent signed Federal income tax form and W2 forms of parents

Include U.S., Puerto Rico or foreign income tax returns (including schedules) and W2 forms for parents. If a parent is self-employed, owns or operates a business, attach a copy of the Business/Farm Supplement.

□ Copy of the College Board PROFILE (CSS/Financial Aid Profile) if one was required for your college financial aid

applications

□ Copy of letter granting or denying financial aid from the college you plan to attend

□ Dean's Evaluation Form. You must ask your Dean to complete the Dean form available online at

If applicable, the following must also be submitted:

□ For non-custodial parents, a separate application form, along with required materials, and a copy of the Noncustodial

PROFILE (available from

□ For foreign citizens who are not submitting a College Board PROFILE, a copy of this year’s International

Student Financial Aid Application (available from

We submit this application to the Scarsdale High School PTA Scholarship Fund for College Grant Committee. We believe that all information provided is true and accurate.

STUDENT SIGNATURE______DATE______

PARENTS/GUARDIANS SIGNATURES______DATE______

E-MAIL ______

______DATE______

E-MAIL ______

Questions? Call Suzanne Glaser (914) 722-1019or email

SUBMIT COMPLETED APPLICATION MATERIALS to

SUZANNE GLASER, 47 AXTELL DRIVE, SCARSDALE, NY 10583

You will by notified by email when we receive your application.

DEADLINE: MAY 2, 2016

TO BE COMPLETED BY THE STUDENT:

Part I.

1. What college/university do you plan to attend next fall?

______

2. If you are waiting for acceptance by any other college or university, please list:
______

______

______

3. If you have applied for financial aid from sources other than your college or university, please list the organizations and/or scholarship funds here:

______

______

______

______

4. List any financial aid, award, loan or gift from sources other than your college or university that you have received:

______

______

______

______

5. Please describe efforts you have made during high school to contribute to financing your college education:

______

______

______

______

6. List all siblings by age and the schools they attend (do not list the names of your siblings)

______

______

Part II.STUDENT STATEMENT

Attach a short (not more than one page) typewritten statement discussing your plans for college.

PART III. ANTICIPATED COSTS WORKSHEET forFreshman Year

Please attach copy of the web page from your college listing expenses of college

Tuition (as set forth in the college letter, invoice or website) ______

Fees (specify)______

Room and board

Living at home______

Living at campus______

Books/supplies______

Transportation______

Other expenses (please specify)______

______

Total costs______

TO BE COMPLETED BY THE PARENTS AND STUDENT:

Name of college/university student plans to attend ______

PART I.ANTICIPATED RESOURCES WORKSHEET

Freshman Year

College Financial Aid package*:

Work-study program______

Loans (i.e. Stafford)______

Grants (i.e. Pell)______

Other Grants/Awards:______

______

______

Parents' contributions:

From income______

From savings & investments______

From loans______

Other______

Student's contributions:

From jobs______

From savings & investments______

From loans______

Other contributions:

From friends/relatives______

Total resources:______

Amount of Scarsdale High School PTA Scholarship Fund aid requested: ______

Are there special circumstances relevant to this application – i.e. disability, alimony or child support issues, business failure, layoff – that the Grant Committee should consider?

NO______YES______(please attach a separate sheet and be as specific as possible)

*If you are unsure of your college financial aid package by the application deadline, please submit your otherwise completed application.

PART II.SUMMARY OF FINANCIAL INFORMATION

Estimated annual family income:LAST YEAR______PRIOR YEAR______

From wages/business:______

From investments:______

Do you own your own home:Yes______No______

If yes, original purchase price:______Year purchased______

A. ASSETS Parent/s Student Total
Bank Balances
(Checking, Savings, Money Market)
Investments
(Stocks, Bonds, Mutual Funds)
Home (estimated market value)
Other Real Estate (est. market value)
Business Ownership value
Pension Assets (401-K, IRA)
Other Assets (specify)
______
______
TOTAL ASSETS: / A.
B. LIABILITIES
Short Term Credit Card
or Bank Debt
Investment Debt
Mortgages on Home
Home Equity/Home Improvement Loans
Other Real Estate Debt
Business Debt
Other Liabilities (specify)
______
______
TOTAL LIABILITIES: / B.
C. NET WORTH Total Assets (A) minus
Total Liabilities (B) = C / C.

1

Initials ______