2010 St. Marys Academy Scholarship Application 

See your HS Counselor for Application Deadline
SECTION I

A. PERSONAL INFORMATION
Student’s Full Name:
Parent/Guardian Name(s):
Address:
City, State and Zip:
E-mail address:
Phone number:
   

B. HIGH SCHOOL INFORMATION

GPA:
ACT:
Class Rank:
Number of students in senior class:
Counselor's Name:
   

C. POST-SECONDARY INFORMATION

Proposed Post-Secondary Program of Study/Major:  

Proposed Post-Secondary School #1 (school name):

Proposed Post-Secondary School #2 (school name):

D. LIST THREE REFERENCES

First Reference

Name:
Address:
City, State and Zip
Phone number:
E-mail Address:
Position:
Relationship to student:

Second Reference
Name:
Address:
City, State and Zip
Phone number:
E-mail Address:
Position:
Relationship to student:

Third Reference
Name:
Address:
City, State and Zip
Phone number:
E-mail Address:
Position:
Relationship to student:

E. ACTIVITIES SUMMARY

Please upload a Microsoft Word document or Adobe PDF that lists your academic honors, awards, extracurricular activities, community service, and work experiences that relate directly to the scholarship(s) for which you are applying. With each activity, provide the date(s) you were involved and any leadership roles you held. Also explain why you are choosing your proposed field of study/major. Please make sure your name is on the document.

Click the "Browse" button to locate your Activities Summary on your computer.

F. CHECK BOX NEXT TO EACH SCHOLARSHIP FOR WHICH YOU ARE APPLYING
     (Click here for more information about each scholarship, including criteria, award amounts, etc.)
Wamego Telephone Company Scholarship *

   *Financial need information is required; please complete Section II, below

SECTION II

FINANCIAL NEED INFORMATION (All financial information will remain confidential)
If you are not applying for a scholarship in which financial need is a consideration, you may skip this section and submit your application using the button at the end of the page.

1. How much do you estimate your first year of college or training will cost?
Tuition:
Books:
Room and Board:
Other:

2. What is the most recent adjusted gross income of family? 

3. How many persons are dependent on the family income?

4. Are there personal or family health issues or other circumstances that pose a financial burden?
    If so, please explain: