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Scholarship Applying For:
____ Undergraduate Student
____ Senior or Graduate Student
Personal Information:
Name______________________________College or University_______________________________________
Address____________________________Telephone______________________
City_______________________________State__________ Zip code__________
Education
List any schools previously attended starting with your high school
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What is your planned course of study
__________________________________________________________________________________________
What is your status- single or married
If married what is your spouse’s name________________________________
Do you have children? If so what ages_______________________________
Are you considered a dependent__________
Father’s Name________________________
Father’s place of employment and position held____________________________________________________
_________________________________________________________________________________________
Mother’s Name________________________
Mother’s place of employment and position held___________________________________________________
_________________________________________________________________________________________
List all dependent children in your parent’s home(Name, age, school/ work)
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Are you presently working?_______If yes, where?__________________________________________________
_________________________________________________________________________________________
What is your position?_______________________________________________________________________
Approximate earnings?______________________________________________________________________
Other financial responsibilities?________________________________________________________________
_________________________________________________________________________________________
List any jobs you have had in the past 2 years_____________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please complete the following information which will be held in strict confidence.
a. Family’s total combined IRS Adjusted Gross Income:
_______under $30,000 _______$76,000-$100,000
_______$31,000-$50,000 _______Over $100,000
_______$51,000-$75,000
b. Your, or if married, you and your spouse’s combined IRS Adjusted Gross Income
_______under $5,000 _______$15,100-$25,000
_______$5,100-$10,000 _______Over $25,000
_______$11,000-$15,000
c. Briefly describe any circumstances of which the committee should be aware in order to help them make their
selection. (i.e. children,illness, medical, dental expenses, etc.)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
d. Check other sources of income from which your education may be financed. ____Personal Savings ____Work
____Help from family ____Scholarships ____Loans
____Other sources
Personal Scholarship Statement:
Please use the following outline to write a 1 to 2 page paper to let the committee know who you are. You may write
it in list form, or if you prefer, in essay form. Please double space.
Educational Goals:
Career Goals:
Personal Goals:
Special Interests:
Financial Need:
What are your campus activities? What do you like to do?
What environmental activities have you been involved with? Volunteer or work related.
Signed____________________________________________________________
Date__________________________
Send to: Berkley Fishing Team Environmental Scholarship
9910 Gerdanville Ave.
Waynesburg, Ohio 44688
If you email the application, sign with the following:
Printed Name________________________________ email address______________________
Date_______________
Email to: jrg95sv@sbcglobal.net
Required Materials:
Application with essay attached
2 Letters of reference
Transcript
____ Undergraduate Student
____ Senior or Graduate Student
Personal Information:
Name______________________________College or University_______________________________________
Address____________________________Telephone______________________
City_______________________________State__________ Zip code__________
Education
List any schools previously attended starting with your high school
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What is your planned course of study
__________________________________________________________________________________________
What is your status- single or married
If married what is your spouse’s name________________________________
Do you have children? If so what ages_______________________________
Are you considered a dependent__________
Father’s Name________________________
Father’s place of employment and position held____________________________________________________
_________________________________________________________________________________________
Mother’s Name________________________
Mother’s place of employment and position held___________________________________________________
_________________________________________________________________________________________
List all dependent children in your parent’s home(Name, age, school/ work)
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Are you presently working?_______If yes, where?__________________________________________________
_________________________________________________________________________________________
What is your position?_______________________________________________________________________
Approximate earnings?______________________________________________________________________
Other financial responsibilities?________________________________________________________________
_________________________________________________________________________________________
List any jobs you have had in the past 2 years_____________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please complete the following information which will be held in strict confidence.
a. Family’s total combined IRS Adjusted Gross Income:
_______under $30,000 _______$76,000-$100,000
_______$31,000-$50,000 _______Over $100,000
_______$51,000-$75,000
b. Your, or if married, you and your spouse’s combined IRS Adjusted Gross Income
_______under $5,000 _______$15,100-$25,000
_______$5,100-$10,000 _______Over $25,000
_______$11,000-$15,000
c. Briefly describe any circumstances of which the committee should be aware in order to help them make their
selection. (i.e. children,illness, medical, dental expenses, etc.)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
d. Check other sources of income from which your education may be financed. ____Personal Savings ____Work
____Help from family ____Scholarships ____Loans
____Other sources
Personal Scholarship Statement:
Please use the following outline to write a 1 to 2 page paper to let the committee know who you are. You may write
it in list form, or if you prefer, in essay form. Please double space.
Educational Goals:
Career Goals:
Personal Goals:
Special Interests:
Financial Need:
What are your campus activities? What do you like to do?
What environmental activities have you been involved with? Volunteer or work related.
Signed____________________________________________________________
Date__________________________
Send to: Berkley Fishing Team Environmental Scholarship
9910 Gerdanville Ave.
Waynesburg, Ohio 44688
If you email the application, sign with the following:
Printed Name________________________________ email address______________________
Date_______________
Email to: jrg95sv@sbcglobal.net
Required Materials:
Application with essay attached
2 Letters of reference
Transcript
| The Berkley Fishing Team Of Ohio Environmental Scholarship Application |
| Copyright 2006 Berkley Fishing Team of Ohio Inc. |
| Please copy and paste into an email or document software. |