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KIWANIS CLUB OF HIGH POINT2016 Two-year Academic orTwo-year Vocational ScholarshipGuilford Technical Community CollegeInformation and Application FormCRITERIA FOR APPLICATION 1. U.S. Citizen and resident of North Carolina2. High School senior attending a senior high school located in High Point, NC3. Financial Need4. Completed application postmarked on or before May 20, 2016APPLICATION FORM - PLEASE PRINT1. Full Name: __________________________________________________________________________2. Home Address :______________________________________________________________________ _____________________________________________________________________________________3. Mailing address ( if different than home address): __________________________________________ ____________________________________________________________________________________4. Email Address: ______________________________________________________________________5. Home Phone: _______________________________________________________________________6. High Schools Attended and Dates attended: _________________________________________________________________________________________________________________________________________________________________________________________________________________________7. Cumulative weighted GPA :________________8. School involvement and accomplishments:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________9. Community involvement accomplishments: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________10. Other personal interests and accomplishments :__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________11. Work experience: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I certify that all information in this application is true and correct. ______________________________________________PRINT NAME, STUDENT_______________________________________________SIGNATURE, STUDENT_______________________________________________PRINT NAME, PRINCIPAL OR GUIDANCE COUNSELOR________________________________________________SIGNTURE, PRINCIPAL OR GUIDANCE COUNSELORFINANCIAL INFORMATIONAll financial matters will be kept confidentialFinancial information forms will be destroyed after evaluation by the Committee1. Student's full name :__________________________________________________2. Parents'/Guardians full name: ___________________________________________3. Permanent Address: ___________________________________________________________________________________________________________________4. Mailing address ( if different than above) :____________________________________________________________________________________________________5. Phone numbers:Cell: ________________________Home: ______________________Work: _______________________6. Student's primary financially responsible parent/guardian: ___________________________________ Place of employment : ____________________________________________________________Job Title: _________________________________ Years in present position:________________Employer's Address: ___________________________________________________________________________________________________________________________________________Annual gross earnings from most recent federal tax return: $ ____________________________7. Other financially responsible parent/guardian: ____________________________________________Place of employment: ___________________________________________________________Job Title: _________________________________ Years in present position: _______________Employer's Address: ___________________________________________________________________________________________________________________________________________Annual gross earnings from most recent federal tax return: $ ____________________________8. Do you own your home? YES / NORent a home/apartment ?YES / NO9. Names and ages of all family members dependent on earnings of student's financially responsible parents/guardians. Those family members currently in school._______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________10. Please provide any comments or special circumstances that would assist in evaluating the student's need for financial aid: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Other scholarships or funding expected or applied for or confirmed.Source Amount ($)__________________________________________________________________________________SourceAmount ($)__________________________________________________________________________________SourceAmount ($)__________________________________________________________________________________Signatures of financially responsible parents/guardians and the student applicant:I certify that all information in this application is true and correct.Signature: ___________________________ Date: ______________________StudentSignature: ____________________________Date: ______________________Financially responsible parent/guardianSignature: ____________________________Date: ______________________Financially responsible parent/guardianTHE FOLLOWING ITEMS MUST BE INCLUDED WITH YOUR APPLICATIONAPPLICATION FORM: TO BE COMPLETED BY STUDENTFINANCIAL INFORMATION FORM: MUST BE COMPLETED BY STUDENT'S FINANCIALLY RESPONSIBLE PARENTS/GUARDIANSTWO LETTERS RECOMMENDATION ( FRON NON-RELATIVES )ONE FROM A MEMBER OF YOUR SCHOOL FACULTYONE FROM AN EMPLOYER, CLERGY, OR COMMUNITY ORGANIZATIONOFFCIAL TRANSCRIPT: OBTAINED BY STUDENT AND INCLUDED IN THE APPLICATION PACKAGEPERSONAL ESSAY:SUBJECT: TELL US ABOUT YOUR STRONGEST CHARACTERISTIC AND HOW THAT HAS PLAYED OUT IN YOUR LIFE.500 WORDS OR LESSTYPED, DOUBLE SPACEDAll items needed to complete this application must be mailed by the student in one envelope addressed to :SCHOLARSHIP COMMITTEEKIWANIS CLUB OF HIGH POINT200 N. MAIN ST. 3RD FLOORHIGH POINT, NC 27261 ................
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