Www.anderson.k12.ky.us
1. Applicant's Name: _______________________________________________________________
Address: ______________________________________________________________________
Date of Birth: _____________
Year of Graduation from ACHS or CAL (circle school): _______________
2. Applicant's year of College for 2015-2016, Fr., Soph., Jr., or Sr. (circle one)
3. Name of University or Technical School: ______________________________________________________________________________
Address:
______________________________________________________________________________
4. Applicant's Proposed Major, Profession, or Vocation _______________________________
5. Applicant's Marital Status: Single________ Married__________
6. While in high school, was student a ward of the court or in foster care? If yes skip # 8 and 9.
7. Does high school student live with someone other than parent or guardian? If yes skip #8and 9.
8. Parent or Guardian Information: Name and Age of Father: _______________________
Address: _______________________________
Occupation: _______________________________
Name and Age of Mother: _______________________________
Address: _______________________________
Occupation: _______________________________
9. Total size of Applicant's Household: ________________________ (number)
10. Parent’s Financial Statement for 2014 calendar year:
Adjusted Gross Income: $_______________________________
11. Parent/Student (EFC) Expected Family Contribution from FAFSA: _______________________
12. Applicant's Expected Resources for Next Academic Year:
Earnings: $______________________________
Parent Assistance: $______________________________
Scholarships: $______________________________
Total: $______________________________
13. Financial Needs for Next Academic Year:
Tuition and Fees: $______________________________
Books and Supplies: $______________________________
Student’s Room: $______________________________
Student’s Board/Meals: $_____________________________
Personal (Clothing, laundry, etc.): $_____________________________
Transportation: $_____________________________
Other Costs: $_____________________________
Total Budget: $_____________________________
Less Amount from all Other Sources: $_____________________________
Balance Needed: $_____________________________
14. List and attach hereto any special recognitions, honors received by you, your significant extra-
curricular activities during high school or later, in your career, including award of other scholarships.
15. Attach hereto two current letters of recommendations. One letter should be from a former teacher
and the other from a non-relative.
16. Write and attach hereto a brief paragraph concerning your desire for continuing education, your
Career plans, and your need for financial assistance.
17. Grade Point Average at present time: (Ms. Miracle to fill out: _______ ACT Score: _______)
Page 2 of 2
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ANDERSON COUNTY SCHOLARSHIP
Application for 2015-2016 School Year
APPLICATIONS MUST BE FULLY COMMPLETED EACH SCHOOL YEAR
DEADLINE: APRIL 15th 2015
I certify that all information contained herein is true to the best of my knowledge and belief.
___________________________________ ___________ _______________________
Applicant's Signature Date Telephone # of Applicant
................
................
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