Application

DR. SUE G. COCHRAN SCHOLARSHIP

To Gulf Coast State College

For Former Cedar Grove Elementary Students

DEADLINE: April 27, 2018

APPLICATIONS RECEIVED AFTER THE DEADLINE ARE NOT ELIGIBLE FOR CONSIDERATION

The Dr. Sue G. Cochran Scholarship is awarded to full-time students or to students planning to attend full-time at Gulf Coast State College.

Eligibility: Must be a former CedarGroveElementary School Student to apply

Applicant must complete Parts I - IVANDattach a photograph in order to be considered for the Dr. Sue G. Cochran Scholarship.

The school counselor or registrar must complete Part V.

Part I:Personal InformationPlease print or type

Applicant’s Full Name: ______SS#______-_____-______

Home Address: ______Zip Code______

(Street) (City) () State)

Date of Birth: ______/______/______Parent/Guardian: ______Phone: (____)______

(Month) (Day) (Year)

Name of high school or college currently attending: ______

Years attended Cedar Grove Elementary School 20______-______

Part II: Financial Statement

By completing this portion of my application for this scholarship, I hereby give permission for my personal financial and academic information and my family’s personal financial information to be reviewed.

CURRENT INCOME/FREQUENCY

List the names of everyone in your household / Annual Gross Earnings (before deductions from Job 1 / Welfare, Child Support, Alimony / Payments from pensions, Retirement, Social Security / Job 2 or any other income
$ / $ / $ / $
$ / $ / $ / $
$ / $ / $ / $
$ / $ / $ / $
$ / $ / $ / $

Name and social security number of the primary wage earner or household member who is listed above and/or signs as Parent/Guardian below.

Name: ______Social Security Number: ______-______-______

Part III:

List your extra-curricular activities, honors, academic honors, awards, offices held: ______

______

Signature of Applicant Date Signature of Parent/Guardian Date

Part IV:Personal Statement(Must be attached in order to be considered for scholarship.)

Attach a short personal statement about yourself, your plans, your goals, your work experiences, and the reason(s) that you would like to be a recipient of this scholarship. (Limit your response to 250 words.)

Part V: To be completed by school counselor or registrar:

1. Applicant’s grade point average______

  1. Date of high school graduation:______
  2. Date, time and location of high school senior awards day ceremony:

______, 2018 at ______(am/pm)

______

(Location)

Additional Comments:______

______

______Signature Position/Title Telephone Date

APPLICATION DEADLINE: FRIDAY, APRIL 27, 2018

Return completed application to: Cedar Grove Elementary School Attention: Yvonne Ammons

2826 E. 15th Street

Panama City, Florida32405