Scholarship
Application
IMPORTANT NOTE:
FILL OUT ONLY ONE APPLICATION FORM TO BE ELIGIBLE FOR ALL
FCS SCHOLARSHIPS.
Mail your completed application to:
University of Montevallo
Station #6385 Bloch Hall
Montevallo, Alabama 35115
ATTN: Scholarship Committee
**Date
Submitted: __________________________
**FCS
Concentration:________________________
**County of Residence: ______________________
(** FCS USE ONLY
PLEASE LEAVE ABOVE INFORMATION BLANK)
Scholarships for which you are applying:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
PERSONAL
INFORMATION:
Name:______________________________________________________________________________
Last, First,
Middle or Maiden Name
Social Security No:_________-________-___________ Race:________
(Optional)
Date of Birth: ____________________
Home Phone
No:
(______) ____________________
Permanent
Address:___________________________________________________________________
Street or
P.O. Box, City,
State & Zip
Mailing
Address:______________________________________________________________________
If different from above
Name &
Address of Hometown Newspaper:
________________________________________________
Please
circle one:
Single
Married
Divorced
Widowed
Parents/Spouse: (Include
titles such as Dr., Sgt. etc.) Indicate if
deceased.
Father/Spouse Name:
_________________________________________________________________
Mother/Spouse
Name:_________________________________________________________________
Name of Guardian, if
other than parent:
___________________________________________________
Number and Ages of
Siblings/Children:___________________________________________________
ACADEMIC
INFORMATION:
(Please attach
separate sheet of paper if needed.)
High School/Community College:
______________________________Phone #: __________________
Current
GPA: ________________ ACT or SAT
Composite Score:______________
Date
ACT/SAT Taken: _______________ Proposed Graduation Date:
______________
High School
Principal: ______________________ Counselor(s):
______________________________
Have you
previously applied to the University of Montevallo?
YES
NO
(circle one)
Were you
accepted?
YES
NO
(circle one)
HONORS AND
ACTIVITIES: Please list all of
your activities, honors, and leadership
positions in high school, community college,
college,
church, clubs/organizations, and community
service. Add additional pages if needed.
High
School/Community College/College:
Church/Clubs/Organizations:
Community Service:
|
STUDENT’S EMPLOYMENT
HISTORY: |
|
Current Employer & address
|
Dates
of Employment:
|
Position: |
|
Supervisor:
|
|
Phone
number:
|
|
Briefly
describe your duties:
|
|
Previous Employer & address
|
Dates
of Employment:
|
Position: |
|
Supervisor:
|
|
Phone
number:
|
|
Briefly
describe your duties:
|
Reason for leaving:
|
|
Previous
Employer & address
|
Dates
of Employment:
|
Position |
|
Supervisor:
|
|
Phone
number:
|
|
Briefly
describe your duties:
|
Reason for leaving:
|
ADDITIONAL
INFORMATION:
Please respond to the
following questions. Add additional pages if needed.
1. To
what personal traits do you attribute your
successes in life?
2. Why should you be awarded a
scholarship from the FCS Department?
FINANCIAL
INFORMATION: (Please list exact amounts of
all income as shown on your FAFSA)
Occupation
of father/guardian/spouse:
__________________________________________________
Annual Income:
$_________________________________
Occupation
of mother/guardian/spouse:
_________________________________________________
Annual Income:
$_________________________________
Occupation of Applicant:
______________________________________________________________
Annual Income:
$_________________________________
Additional income (alimony,
retirement, etc...) $_________________
TOTAL INCOME:
$____________________________________________
Below
please state
the amount of financial assistance you expect
to receive from parents, spouse, guardians or other
sources while you are in school.
Have you applied
for other scholarships/financial aid?
YES
NO
(circle one)
Was
aid granted?
YES
NO
(circle one)
If
Yes: Amount(s)$___________
Amount(s)$___________
Source(s):
________________________________________________________
Describe some of your needs for
financial assistance(Ex: Does your family
have medical expenses, other dependents, others in
college, etc.?):
|
CERTIFICATION: |
|
I hereby
certify that the information in this
application is accurate to the best of my
knowledge. FCS scholarships will be
canceled immediately if any of the
information presented is identified as
intentionally erroneous. |
Applicant:_______________________________________________________ |
Date: |
_________ |
|
Parent/Guardian/Spouse:__________________________________________ |
Date: |
_________ |
|
The information in this application will
be considered strictly confidential. |
It is the policy of the University of
Montevallo not to discriminate on the basis
of gender, handicap, race, color, religion,
or national or ethnic origin in awarding
financial aid.
|
