The Jerome and Phyllis Cumins Education Scholarship Award

2010

The annual Jerome and Phyllis Cumins Education Scholarship Award will be presented to an Augusta area Jewish student enrolled in a post high school education program. The award will be disbursed in a single payment of $1000.00. The Award winner will be selected using criteria of community involvement, quality and content of an essay, academic performance and financial need. The winner will be announced in June and the funds made available for either the summer or fall school semester.

To qualify, a student must:

  1. Be a post high school Jewish full-time student from the Augusta area.
  2. Be of good academic standing.
  3. Have demonstrated leadership, participated in extracurricular activities and demonstrated involvement in community service.

Applicants must:

  1. Complete the application form.
  2. Compose and attach an essay (500 words minimum) highlighting how experiences growing up in the Augusta Jewish Community have shaped his/her life and influenced his/her plans for the future.

Contact information

Name ______

Local Address ______

Email Address ______

Phone (home) ______(cell) ______

Date of Birth ______Social Security # ______

Applicant Statement

  1. I am Jewish.
  2. The information provided in my application is, to the best of my knowledge, complete and accurate, and I understand that false statements on this application will disqualify me.

Applicant’s Signature ______

Send application by April 1, 2010 to:

The Jerome and Phyllis Cumins Education Scholarship Award

C/o Leah Ronen, Executive Director

Augusta Jewish Community Center

898 Weinberger Way, Evans, GA 30809

The Jerome and Phyllis Cumins Education Scholarship Award

2010

Name: ______

Financial Information

Please provide a description and an estimate of education expenses for next semester/year

______

______

Name any sources of financial aid (including scholarships) that you expect to receive during the next year. Indicate approximate amounts.

______

______

If a Dependent:

Name of Parent(s)/Guardian(s) ______

Dependents of same Parent(s)/Guardian(s) and schools they are (will be) attending.

Names School

______

______

______

______

Occupation(s) of Parent(s)/Guardian(s)

______

Total Parent(s)/Guardian(s) Annual Income

_____ Under $50,000_____ Between $75,000 and $100,000

_____ Between $50,000 and $75,000_____ Above $100,000

Education Expenses earned by the applicant and source

______

______

Education Expenses covered from other sources

______

______

If self-supporting:

Total income from employment ______

Total income from other sources, including spouse ______

Please provide any additional information that would indicate your financial need.

The Jerome and Phyllis Cumins Education Scholarship Award

2010

Name: ______

Education, Achievements, Aspirations and Community Activities

Education and Activities

School currently attending: ______

Current grade/semester ______

Continuing Education at (if different from above, pending schools may be noted)

______

Target post high school major: ______

Expected graduate date ______Degree ______

Last semester grade point average ______Cumulative GPA ______

List previous high schools, college and universities attended:

______

______

______

Academic Honors

______

______

______

______

______

Extracurricular Activities

(Include any Augusta Jewish youth activities)

Activity/Organization Role

______

______

______

______

______

______

______

______

______

______

______

The Jerome and Phyllis Cumins Education Scholarship Award

2010

Name: ______

Education, Achievement, Aspiration and Community Activities, (continued).

Community Service/Public Service ProjectsRole

______

______

______

______

______

______

______

References

Provide names, relationship to applicant, addresses, telephone numbers and email addresses or three references that can address the applicant’s character and commitment to completing his/her education. Please do not include relatives.

Name ______Relationship ______

Address ______City ______State ______Zip ______

Phone ______email ______

Name ______Relationship ______

Address ______City ______State ______Zip ______

Phone ______email ______

Name ______Relationship ______

Address ______City ______State ______Zip ______

Phone ______email ______