THE MARY H. BAILEY EDUCATIONAL TRUST FUND

THE MARY H. BAILEY EDUCATIONAL TRUST FUND Established Under the Will of Mary H. Bailey BNY Mellon Trust of Delaware

INDIAN RIVER SCHOOL DISTRICT Sussex Central High School

FIRST YEAR STUDENT APPLICATION

Name of Applicant

INSTRUCTIONS

1) All questions must be answered completely. If the answer to any question is "no" so indicate; or if the question does not apply, place a N/A in the space An incomplete and/or unsigned application will not be considered. 2) Additional information, if thought necessary to explain in more detail, may be written on a sheet of paper and attached to this form. Use the number of the section to reference the attached material. 3) All information furnished in connection with a student's application for a Mary H. Bailey Educational Trust Fund Scholarship will be treated confidentially. 4) The following documents MUST BE INCLUDED IN THE APPLICATION PACKET and returned to the Guidance Office by March 29, 2019.

First Year Student Application Official transcript

Updated October 2018

Page 1

POLICIES

BAILEY SCHOLARSHIPS are awarded to worthy and deserving students who are graduates of Sussex Central High School to assist them in financing their education beyond high school. The scholarships are intended to augment students' resources for educational expenses and not to meet total college/school costs for a school year or degree programs.

BAILEY SCHOLARSHIPS are not awarded or renewed: 1. For more than four years 2. For graduate/professional study beyond the baccalaureate degree 3. To students that do not maintain a 2.5 GPA

Updated October 2018

Page 2

PERSONAL & FINANCIAL INFORMATION

1) NAME LAST, FIRST MIDDLE

HOME PHONE

2) HOME STREET ADDRESS

CITY STATE ZIP CODE

3) EMAIL ADDRESS

CELL PHONE (optional)

4) DATE OF BIRTH Month Day Year

5) FATHER (Or Guardian)

NAME

LAST

FIRST

MIDDLE

6) HOME STREET ADDRESS

CITY STATE ZIP CODE

7) MOTHER (Or Guardian)

NAME

LAST

FIRST

MIDDLE

____________________________________________________________________________

8) HOME STREET ADDRESS.

CITY STATE ZIP CODE

9) FATHER'S EMPLOYER

10) MOTHER'S EMPLOYER

11) FATHER'S ANNUAL INCOME

12) MOTHER'S ANNUAL INCOME

Updated October 2018

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13) LIST ANY OTHER RESOURCES AVAILABLE TO APPLY TOWARD YOUR EDUCATION EXPENSES:

HIGH SCHOOL ACTIVITIES

14) LIST THE SCHOOL ACTIVITIES YOU ARE INVOLVED IN:

School Activity

How Many Years?

15) LIST THE SPORTS TEAMS THAT YOU ARE A MEMBER OF:

Sports Team

How Many Years?

16) LIST ANY OFFICER/LEADERSHIP POSITIONS:

A. __________________________________________ B. __________________________________________ C. __________________________________________ D. __________________________________________ E. __________________________________________

Updated October 2018

Page 4

17) LIST ANY COMMUNITY SERVICE ACTIVITIES AND HOW OFTEN YOU SERVE:

Community Service

How Often?

18) LIST YOUR WORK EXPERIENCE: Company Name

Position

Length of Time

COLLEGE INFORMATION.

19) NAME OF COLLEGE/SCHOOL

A. STUDENT ID AT COLLEGE#_______________________________________

20) ADDRESS

21) DATE OF FIRST ENROLLMENT ____________________________________________

A. EXPECTED DATE OF GRADUATION _______________________________

22) MAJOR COURSE OF STUDY

23) DEGREE/DIPLOMA EXPECTED

24) PLEASE SHARE YOUR FUTURE COLLEGE AND CAREER GOALS.______________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

Updated October 2018

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25) GIVE YOUR CUMULATIVE GRADE POINT AVERAGE

26) GIVE YOUR GRADE POINT AVERAGE FOR THIS ACADEMIC YEAR

27) Budget for school year for which this application for BAILEY SCHOLARSHIP is made. In the budget below, total estimated expenses should be balanced by total estimated resources. An incomplete budget or obviously inflated expense budget may be cause for rejecting the application. If applicant is unable to complete any part of the budget, an explanatory statement should be attached.

28) Indicate the Estimated Cost of your College/School expenses (based upon information in the institution's catalog or bulletin) for the year for which you are applying for a BAILEY SCHOLARSHIP. Attach copy of the schools estimated expense sheet.

Tuition & Fees

$

Room

$

Board

$

Books & School Supplies $

Clothing

$

Health

$

Insurance

$

Laundry & Dry Cleaning

$

Transportation (must itemize)

$

Other Expenses (must itemize)

$

TOTAL ESTIMATED EXPENSES $

TOTAL RESOURCES

$

(Sum of 11, 12, 13)

29) Are you related to any IRSD School Board Member(s)?______If yes, list name(s) _____________________________________________________________________________

30) Are you related to any current Sussex Central High School Staff Member(s)? ___________ If yes, list name (s) _____________________________________________________________

I have read the POLICIES statement and I have checked my answers to all the questions on this application. I certify that the information given herein is true and complete. I acknowledge that any mis-statement or misrepresentation of fact may result in my disqualification for favorable consideration of a scholarship award.

DATE

SIGNED

Student Applicant

Updated October 2018

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