STUDENT APPLICATION GFA SCHOLARSHIP - PART I

Name of GFA member: must be applicant or applicant’s parent _______________________________________________________________________________

Griswold Line, if known (please circle one): Edward     Michael     Matthew     Francis

APPLICANT INFORMATION: (Please print legibly)

Name _______________________________               SSN or student number______________

           Last                  First          M.I.

Home Mailing Address __________________________________________________________

Home Phone (       )____________ Date of Birth _____

E-mail address________________________________Alternate E-mail ________________________

Father or Guardian Name ________________________________________________________

Mother or Guardian Name _______________________________________________________

  1. U. S. Citizen? Yes _______ No __________

  2. High School(s) Attended? ______________________________________________________ ______________________________________________________

  3. High School Graduation Date ____________________

  4. Institution of higher learning to which applicant's scholarship award is requested (if known; we recognize that some have college applications pending on admission results):

    Institution __________________________ Location ______________  Major   __________________

  5. Will you commute from home? ___ Live on Campus? ___ Off-campus apartment?________

  6. Parent's or Guardian's occupation & employer:
     
    Father ___________________ _______________
    |
    Mother __________________________________

  7. Other family members in same household. 
    ___________________________________________________________________________
                            Relationship                      Age                                                           Status (Employed-student-etc.) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
  8. Other scholarships, grants, loans, etc. you are seeking or have received:
    ______________________________________________________________________________
                Source                      Amount Sought                                        Amount Received _____________________________________________________________________________ _____________________________________________________________________________
    _____________________________________________________________________________

    PLEASE COMPLETE IN DETAIL THE FOLLOWING QUESTIONS. ATTACH ADDITIONAL SHEETS OF PAPER FOR COMPLETE ANSWERS AND IDENTIFY WITH APPROPRIATE LETTERS:

     
    A. Describe your work experience, indicating period of time in each job, rates of pay, and duties/responsibilities.

    B. List your memberships and participation in school and community organizations and activities.

    C. Prepare a statement of your aspirations, and give other information you feel will help the award selection committee.

    D. Indicate unusual family or personal circumstances, if any, which you feel warrant the attention of the award selection committee. I hereby give permission to my high school to release a copy of my transcripts of grades, class rank, college board scores. I further certify that the information contained in this application is complete and accurate, to the best of my knowledge.

    Applicant's signature ______________________________

    TO THE APPLICANT'S HIGH SCHOOL COUNSELOR (if applicable): Please attach comments about any unusual factors which you feel warrant special attention, and attach applicant's class rank, college board scores, and official transcript.

    Counselor's Signature _____________________________