The Hirsch Family Scholarship

2017SCHOLARSHIP APPLICATION

THE HIRSCH FAMILY SCHOLARSHIP

OF THE DALLAS FOUNDATION

The Hirsch family established a scholarship fund in 2009. It currently benefits dependent children of active employees of Eagle Materials, Highlander Partners, Ascend, Lund, JuiceTyme,Profile Custom Extrusions,or any of their majority-owned subsidiaries (the Companies). Based on academic achievementand taking into consideration financial need, scholarships will be awarded annually, varying between $2,500 and $10,000 per award.

Applications will be accepted between January 3, 2017, and April 10, 2017. If you have satisfied the eligibility criteria below, please submit a completed application to:

The Dallas Foundation

Reagan Place at Old Parkland

3963 Maple Avenue, Suite 390

Dallas, Texas 75219

We must receive the applications on or before the deadline of April 10, 2017. Please ensure that all the attachments listed at the end of this application are submitted. The Scholarship Committee reserves the right not to review any applications that are incomplete.

Final awards will be determined in May, following the April 10, 2017 deadline. Confirmation of the student’s enrollment will be required, with the actual payment made directly to the educational institution.

ELIGIBILITY

You are eligible to apply for a Hirsch Family Scholarship if:

• You are the dependent child of an active employee of the Companies and the employee (parent) can claim you as a dependent for federal income tax purposes.

• You are a graduating high school senior who has been accepted in, or a student already enrolled in, an undergraduate program of study in pursuit of a degree from a public or private, regionally accredited community college, college, university, or vocational or trade institute.

• You have a proven record of academic performance, as evidenced by grade point average and/or class rank.

• You are able to demonstrate financial need.

THE HIRSCH FAMILY SCHOLARSHIP APPLICATION

(Please type or print neatly in black or blue ink)

Note: you must (1) complete all portions of the application, including high school information, even if you already

attend a college/university and (2) send required attachments.

CONTACT INFORMATION

STUDENT NAME:

Mr./Ms.FirstMILast

BIRTHDATE:

PERMANENT ADDRESS:

Street Address

CityStateZIP

TelephoneEmail address

CURRENT ADDRESS AND TELEPHONE NUMBER (IF DIFFERENT FROM ABOVE):

Street Address

CityStateZIPTelephone

QUALIFYING COMPANY EMPLOYEE:

CIRCLE: MOTHERFATHEROTHER

Employee Name: SS#

Employee Telephone Number:

Employed by:

Date first employed:

Employee’s direct supervisor:

NameTelephone number

HIGH SCHOOL INFORMATION

HIGH SCHOOL:

NameTelephone number

GRADUATION DATE (MONTH/YEAR):

HIGH SCHOOL GPA: GPA SCALE

(ex: 0 to 4.0, 0 to 5.0)

CIRCLE: Weighted Unweighted

(Your GPA is weighted if your school gives extra grade points for honors courses, such as counting an A in an honors course as a 4.2 instead of a 4.0, and includes those extra points when calculating your GPA.)

CLASS SIZE:CLASS RANK: or My school does not rank

ACT SCORE: SAT SCORE:

(If you took a test more than once, you may use your highest score.)

COLLEGE INFORMATION

SCHOOL YOU ARE CURRENTLY ATTENDING:

UPCOMING YEAR IN SCHOOL Undergraduate (circle) 1 2 3 4

CURRENT GPA ______CURRENT CLASS RANK ______

EXPECTED GRADUATION DATE:

EXPECTED MAJOR:

INTENDED CAREER, IF KNOWN:

COLLEGE OR UNIVERSITY FOR WHICH YOU ARE REQUESTING AID:

List below the name of the school for which you are requesting aid, along with the location, the cost of attendance at that school, and whether or not you have been accepted. (The financial aid office at the school should be able to provide you with the cost of attendance.) The cost includes tuition and fees, on-campus room and board (or a housing and food allowance for off-campus students), and allowances for books and other expenses. If you have not decided which school you will attend, rank in order of preference.

SCHOOL CITY, STATE COST PER YEAR ACCEPTED?

1.

2.

3.

FINANCIAL INFORMATION

Please complete the following AND send the attached Financial Aid Survey to the financial aid office of the college(s) you will attend and ask them to return the form to The Dallas Foundation by April 10, 2017.

NOTE: We must have this completed form available to us in order to review your scholarship application. It is your responsibility to check with the financial aid office to ensure that they send the information on time.

CHECK:I have applied for federal or state student financial aid

I intend to apply for federal or state student financial aid

I do not intend to apply for federal or state student financial aid

ANNUAL FAMILY INCOME: $

(for the twelve months prior to January 1)

PARENTS’ MARITAL STATUS: Married Divorced Separated Widowed

NUMBER OF EACH CURRENTLY LIVING IN YOUR HOUSEHOLD:

Parents

Siblings

Grandparents

Other

NUMBER OF IMMEDIATE FAMILY MEMBERS

ATTENDING COLLEGE THIS COMING SCHOOL YEAR

(i.e., Fall, Winter, Spring year)

REQUIRED ATTACHMENTS

Application, and the following required documents are due at The Dallas Foundation office by April 10, 2017.

1. Certified high school TRANSCRIPT showing GPA and class rank;

1. If you are already enrolled in college, a certified COLLEGE TRANSCRIPT showing GPA on class work to date;

1. A copy of the completed Free Application for Federal Student Aid (FAFSA) or the completed Student Aid Report (SAR);

1. A typed essay of no more than 500 words. This PERSONAL STATEMENT should describe your individual character and accomplishments, career and educational goals, as well as your motivation and the obstacles you face in pursuing your higher education. Please also include why you believe you deserve a Hirsch Family Scholarship and why you need financial help to pursue your education;

1. Please describe the following in no more than three pages:

EXTRACURRICULAR ACTIVITIES you have participated in during the past year, such as student government, sports, and clubs, including offices held and any special honors you have received;

COMMUNITY SERVICE activities in which you have participated in the past four years, including the number of hours per week spent on the activity and how many days, months, or years you participated in the activity; and

WORK EXPERIENCE you have had in the past four years, including your length of employment, and the number of hours you worked per week and how much you earned.

1. At least one, but no more than three, LETTERS OF RECOMMENDATION written on your behalf by persons not related to you (such as teachers, counselors and supervisors). The letters should be delivered in sealed envelopes along with the application, and the persons signing the letters should also write their signatures across the flap of the sealed envelope. Each of your references should include a telephone number where he or she can be reached during the business day.

It is the responsibility of each scholarship applicant to submit all of the required items on or before the application deadline of April 10, 2017. Faxed applications will not be accepted. Due to the volume of scholarship applications, The Dallas Foundation cannot assemble items that are missing from applications. For that reason,

SEND COMPLETED APPLICATIONS TO:

The Dallas Foundation

Reagan Place at Old Parkland

3963 Maple Avenue, Suite 390

Dallas, Texas 75219

(214) 741-9898

THE HIRSCH FAMILY SCHOLARSHIP FUND

FINANCIAL AID SURVEY

To the scholarship applicant: Please provide the information requested above the horizontal double line, and then please submit this form to the Student Financial Aid Office, where they will complete the remainder.

I authorize ______(college/university/vocational school) to release the information requested below to The Dallas Foundation for consideration during the scholarship selection process.

Name of Student: ______

Address: ______

Social Security Number: ______Phone: ______

Student’s Signature: ______Date: ______

To the Financial Aid Office: The student named above is applying for a Hirsch Family Scholarship from The Dallas Foundation. Please complete the following information and return it directly to:

The Dallas Foundation

Reagan Place at Old Parkland

3963 Maple Avenue, Suite 390

Dallas, Texas 75219

214-741-9898 (phone)

214-741-9848 (fax)

The Scholarship Review Committee thanks you for your assistance and requests that this form be returned to The Dallas Foundation before April 10, 2017. Fax copies are acceptable if signed by the person completing the form.

All information should reflect the figures applicable for the upcoming academic year.

1. College Cost/Budget:

1. Parent Contribution:

1. Student Contribution:

1. Calculated Need:

1. This student was evaluated as a dependent or independent student.

1. Does this student demonstrate need under Federal Methodology? Yes No

1. Do you believe that there are special circumstances that would warrant special consideration? Please explain.

______

______

______

1. Package offered:

Gift aid:

Scholarships______

Grants______

Other______

Other aid:

Government Student Loans: ______

Institutional Loans: ______

Work Study: ______

Other: ______

1. TOTAL FINANCIAL AID OFFER: ______

1. UNMET NEED (need minus aid): ______

1. This financial aid package information is based on: estimated or verified information.

1. Person completing this form:

Name:

Title:

College/University:

Address:

Telephone:

E-mail address:

Signature of the Authorized Representative

of the Student Financial Aid Office

Title

1