CIVITAN SCHOLARSHIP APPLICATION



Application for DREAM Scholarship of Henderson CountyNEW APPLICANTS(Do not use any other application form to apply for a Henderson County DREAM Scholarship)General Information Name LastFirstMiddleAddress: Street/ P.O. Box/Rural Route CityStateZip SexMFDate of Birth: Phone No: Email: High School: Parents or Step Parents InformationFather's name Address Occupation Employer Approximate Annual Income Mother's name Address Occupation Employer Approximate Annual Income Brothers (number) Ages Sisters (number) Ages Brothers/sisters in college Scholastic AchievementCollege Entrance Exams Taken: Yes NoList exams and scores Class rank: ____/____ Weighted and un-weighted GPA: / What college are you planning to attend? Application submitted? Status Intended major field of study 56534057239000Employment:Employment: List jobs worked - most recent firstType of work Employer Amount Earned WhenDo you plan to work this summer? Yes NoBudget Information: All financial aid applied for: Grants Scholarships College aid Unmet Need = $ less equals Expenses Resources Net Need682414206900 The following questions are to be answered in ESSAY form. (Please attach as many sheets as necessary.)What is your vocational/career goal?In what extracurricular activities have you participated? What offices have you held?What are your hobbies/interests?What volunteer and community services are you involved in?Why do you need the DREAM scholarship?679451143000 Attach current transcript through last semester6824015977400 Attach two letters of referenceAffirmation and SignatureI hereby give my school officials permission to release all information requested in this application. I also affirm the information herein is correct to the best of my knowledge. I will notify the DREAM Scholarship committee if there is any change in my information that would materially affect the information in my application.564515013716000Date: Signature: ................
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