Zach Jones Memorial Fund

Scholarship Application

Please complete all sections of this application by typing or printing, using black ink. Use N/A if a question does not apply. Appearance and completeness of application will be considered during evaluation. Mail to the Zach Jones Memorial Fund, 6942 FM 1960 E., # 330, Humble, TX 77346-2706. All sections must be completed in order for application to be considered.

The application must be postmarked by March 1

I.PERSONAL INFORMATION

A.Full name______SS#______

  1. Home address______

______

C.Full name of school currently attending______

School address______

D.Home telephone ______School telephone______

E.Cell Phone ______Email address ______

F.Present age______Date of birth______

G.Country of citizenship______

H.Parent or legal guardian’s name______

Address______

I.What four adjectives have others used to describe you?

1.______

2.______

3.______

4.______

J.What do you perceive as your four strongest attributes?

1.______

2.______

3.______

4.______

K.Please list two references and submit a letter of recommendation from each.

  1. Name______

Relationship______

Address______

Telephone______

  1. Name______

Relationship______

Address______

Telephone______

I agree that the application and the attachments may be used for the purpose of evaluation and selection by the Scholarship Committee. I also state that all information enclosed is true and correct to the best of my knowledge. False information is cause for disqualification.

Signature______Date______

  1. EMPLOYMENT HISTORY

List below full-time employment, summer employment, or other part-time employment, briefly explain duties and responsibilities (beginning with your most recent job). If part-time employment, indicate number of hours per week. Add additional sheets as necessary.

  1. Dates employed______

Company______

Address______

Supervisors Name______Phone______

Position______

Your duties______

  1. Dates employed______

Company______

Address______

Supervisors Name______Phone______

Position______

Your duties______

III.FINANCIAL INFORMATION (Complete all blanks)

A.Father’s occupation______

Income  20k to 30k  30k to 40k  40k to 60k  60k & up

B. Mother’s occupation______

Income  20k to 30k  30k to 40k  40k to 60k  60k & up

  1. Please attach a copy of page one and two of your parent’s prior year Form1040

tax return form. You may choose to cover Social Security numbers. These will be shredded after application has been processed.

  1. SCHOLASTIC INFORMATION
  1. What is your cumulative grade point average? GPA: ______

As of which semester completed? Senior fall Senior spring

  1. IMPORTANT! Attach an official transcript from the high school you are presently attending.
  1. In what extracurricular activities have you participated while attending high school? Indicate elected offices held, if any. Specify purpose of local organization. Add additional sheets as necessary.

1.Student activities (student government, Key Club, National Honor Society, etc.)

______

______

______

2.Community activities (Boy Scouts, Girl Scouts, etc.)

______

______

______

3.Athletics

______

______

______

4.Other Activities

______

______

______

  1. ADDITIONAL INFORMATION

Answer the following questions using only the space provided. Any additional sheets will not be considered.

  1. Why are you interested in your career choice and what event, or series of events have led you to this decision? Where possible, explain how your previous work experiences will relate to your career.

______

______

______

______

______

______

______

______

  1. What has been your most important extracurricular activity, your most important

contribution to it, and what has your participation in it meant to you as an individual?

______

______

______

______

______

______

______

______

  1. What college or vocational school do you plan to attend? If your final decision has not yet been made, indicate which schools you are considering, listing the most likely choice first and others in descending order.

______

______

______

______

______

______

______

______

______

ESSAY

In 250 - 500 words, describe how your work ethic, your academic endeavors, and your participation in athletics and/or Fine Arts have contributed to the development of your character, and how they will affect your future educational and career aspirations.

*Athletics is not a requirement for our scholarship.

______

______

Application Checklist

Please include:

Transcript of Grades

Essay

Postmarked before March 1st

Two letters of recommendation

Financial Information 1040 form

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