Scholarship Application

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth

Email

Telephone Number(s)

Name, town, and state of high school

Year of high school graduation/GED certificate granted

TEST SCORES:

ACT Score:

SAT Critical Reading Score:

SAT Math Score:

SAT Writing Score:

COLLEGE INFORMATION:

Indicate the school you plan on attending next fall.

School/Location

Major

Degree Sought

Years of scholarship requested:

2 years
4 years
Other (less than 4, please specify)

If you answered less than 4 years. Please specify.

EMPLOYMENT HISTORY:

Please list your most recent employment.

Job Title

Employer

Hours worked / week

Dates of Employment

Job Title

Employer

Hours worked / week

Dates of Employment

Are you currently employed?

Yes
No

Do you contribute to household expenses?

Yes
No

If yes, how much per month?

PARENT INFORMATION:

Do not complete if you are married or over age 21.

Father's Name

First Last

Father's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Father's Occupation:

Father's Employer

Mother's Name

First Last

Mother's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mother's Occupation:

Mother's Employer

FAMILY INFORMATION:

Do NOT include yourself in the count of siblings.

Total Number of siblings

Siblings at home

Siblings at college

Other dependents that live with your parents:

Please specify:

Your marital status

Number of dependents:

SPOUSE'S INFORMATION: (If applicable)

Spouse's Name:

Spouse's occupation:

Spouse's Employer:

INCOME INFORMATION:

Please estimate your parents’ total gross income and your total gross income for the last calendar year. If married, please include your spouse’s income with yours.

Parents Estimated Income:

Under $10,000
$10,000 - $25,000
$25,001 - $40,000
40,001 - $50,000
$50,001 - 60,000
$60,001 - $80,000

Self/Spouse Estimated Income:

Under $10,000
$10,000 - $25,000
$25,001 - $40,000
40,001 - $50,000
$50,001 - 60,000
$60,001 - $80,000

To the best of your knowledge, please indicate by percentage the source of the actual funds you have available for college expenses:

NOTE: A 100% total would indicate that all college expenses are covered. Your total may be less than that amount. Do NOT include loans.

Self/Spouse:

Parents:

College Scholarships:

Other:

Please specify other sources.

Have you applied for: FAFSA?

Yes
No

Have you applied for other financial aid?

Yes
No

ACHIEVEMENTS AND ACTIVITIES:

Achievements, Honors and Recognition:

Extracurricular/Volunteer activities:

ESSAY SECTION:

Please answer the following questions as completely as possible. If more room in needed, attach extra sheets of paper, labeled with your name and the question number.

1. Is there any information concerning your financial or home situation that might be pertinent to this application for scholarship aid?

2. What are your reasons for seeking a college education?

3. What are your career plans?

4. What are your goals?

REFERENCES:

List the three people whom you asked to complete Confidential References:

1. Name of reference

2. Name of reference

3. Name of reference

To the best of my knowledge, the foregoing statements are accurate:

The scholarship deadline is 5:00 P.M., May 16. There are no exceptions. Please send this form and all other application material including transcript to: Debco Construction PO Box 363 Orofino, ID 83544

Applicant Signature

First Last

Date

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