The Harold B. & Dorothy A. Snyder Foundation, Inc.

P.O. BOX 671

MOORESTOWN, NEW JERSEY 08057-0671

SCHOLARSHIP APPLICATION

Name ______Phone (____)______

Permanent Address ______

StreetCityStateZip

Mailing address at college ______

______Phone (____)______

Social Security No. ______Date & Place of Birth ______

Father’s NameMother’s Name

Or Husband ______or Wife ______

Address ______Address ______

______

Phone Number ______Phone Number ______

His Employer (of previous occupationHer Employer (or previous occupation

if not presently working)if not presently working)

______

Position ______Position ______

Yearly Gross Income (while working)Yearly Gross Income (while working)

______

I am a:___ Sophomore___ Junior___ Senior.

I have the following degrees / licenses (include data received and from where)

______

My gross yearly income is $ ______

How did you learn about the Harold B. & Dorothy A. Snyder Scholarships?

______

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High School Attended______Graduation Date ______

NameStateMonth/Year

College for which ______Graduation Date ______

aid is requestedNameStateMonth/Year

School is ___ college or university ___ vocational school___ divinity school

I will be enrolled___ less than half time ___ half time or more___ full time

Upcoming year in school (circle)Undergraduate 1 2 3 4Graduate 5 6 7 8

Major/Minor field of study and degree sought ______

______

Other Institutions attended (Name, State, Dates, Program) ______

______

______

EXTRACURRICULAR ACTIVITIES(attach additional sheet if necessary): List all school and community activities in which you have participated this year and last year - i.e., sports, student government, clubs, volunteer projects, etc.)

Dates Honors Given

OrganizationParticipatedand/or Offices Held

______

______

______

______

______

______

______

______

SCHOLARSHIP APPLICATION

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WORK EXPERIENCE: List all paid work experiences you have had. Include payments in kind. (Attach additional sheet if necessary.)

PositionDates fromDates toHoursCash Earnings

(mo/yr)(mo/yr)per Weekand Benefits

______

______

______

______

______

______

______

In 500 words or less, please explain:

  1. Do you think voluntary community service is important? If so, why? If not, why?
  1. What does it mean to you to be a citizen of the United States?
  1. How would you respond to this statement from the Charter of the Snyder Foundation?

“While it is not a condition of the scholarship awards, it is suggested the beneficiaries, upon completion of their studies and becoming gainfully employed, make contributions according to their abilities, an amount which may equal to or in excess of the amount expended on their behalf.”

SCHOLARSHIP APPLICATION

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FINANCIAL INFORMATION

List all Financial Aid (scholarships, grants, loans) you have applied for, are receiving, or have received in the past.

AmountInterest

SourceDatesReceivedRate

______

______

______

______

______

Total size of parents’ household during this current academic year. (Include the student named on this form if a member of parents’ household.) ______

Family members in college during this current academic year (include yourself). ______

Provide information below for all children and other dependents.

Name of Institution to beYear in

NameAgeattended in the Fallschool now

______

______

______

______

______

______

______

SCHOLARSHIP APPLICATION

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IMPORTANT: If you or your parents have submitted/plan to submit an application for financial aid through your school or a financial institution, submit a copy of all FAF and FAFSA forms.

PARENTS’ ASSETS AND INDEBTEDNESS

PresentUnpaid

Market ValueMortgage Principal

Home, if owned or being purchased______

Year purchased ______

Purchase price ______

Other real estate ______

Investments (stocks, bonds, other securities)______

Business (include your share of all business assets)______

Cash, savings, checking accounts______

Other indebtedness______

By signing this application form, I hereby authorize the college I will attend to release copies of my transcript and information on financial aid awarded to me by the college and other sources to the Harold B. & Dorothy A. Snyder Foundation. I/We certify that all the information submitted as part of this application is true and correct and that any scholarship awarded is subject to being paid back if any of the information is found to be inaccurate.

Student’s Signature ______Date ______

Legal Guardian or Spouse Signature ______Date ______

SCHOLARSHIP APPLICATION

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REFERENCES: On the lines below, provide the names, titles, full addresses, and phone numbers of the persons from each of the categories listed below who will write a reference letter for you. These persons, not you, should mail the reference letter no later than April 20, 2016 to NJIT’s Scholarship Coordinator. As a courtesy, you should provide each of these persons with an addressed and stamped envelope:

New Jersey Institute of Technology

323 Martin Luther King, Jr. Blvd.

Newark, NJ 07102

Attn.: Darlene Lamourt, 302 Eberhardt Hall

  1. Your high school counselor or your current college faculty advisor.

______

______

______

______

  1. A faculty member, under whom you have studied, from your major field of study.

______

______

______

______

  1. A faculty member, under whom you have studied, outside your major field.

______

______

______

______

  1. Your current or most recent employer.

______

______