Scholarship Application Form

EHS Class of Õ64 Scholarship Fund

 

1.  Please Type or Print your answers to all questions.  Put N.A. if the question is not applicable to you.

 

2.  To be eligible for this scholarship, you must be related in some way, no matter how distantly, to a member of the EHS Class of Õ64.  You can be related by blood or marriage; it does not matter or make a difference.

 

3.  You must attach copies of your Scholastic Record -- high school and college, if applicable and other items listed at the end of this form. 

 

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______________________________________     ____________________________            ________________  

Last Name                                                                   First Name                                          Middle

 

Permanent Address: ________________________________________________________________________

 

                                    ______________________________________________________________________

 

Sex:  M____   F____     Your Social Security #: ______________________ Date of Birth _________________

 

Place of Birth: _____________________________________________________________________________

 

Name of your EHS Class of Õ64 relative: _______________________________________________________

 

How are you related to this person: ____________________________________________________________

 

Is this application for:  College _____  Advanced Degree: ____  Other: ________________________________

 

Are you still dependent on your parents for financial support?  Yes____  No _____  

 

If yes, list your parentsÕ occupations: __________________________________________________________

 

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ParentÕs total annual income:  $__________________ # of siblings: ______  # attending college now _______

 

Your estimated income next year: $______________  Other aid (loans, grants, etc.) $____________________

 

Describe other aid: ________________________________________________________________________

 

Estimated cost of your education next year: $_________________  Are you enrolled now? Yes ____  No____

 

Where will you be attending school in the coming year? ___________________________________________

 

What will be your major or main area of interest? _________________________________________________

 

Will you be a:  full-time student ____  or a part-time student _____?  How many hours per semester? ________

 

 

 

 

 

Page 2                         Scholarship Application Form Ð EHS Class of Ô64

 

Do you plan to work while continuing your education?: Yes  ____  No ____

 

Grade Average (cumulative) in high school: ________  Grade Average in College (if applicable): _________

 

Where did you attend High School:  (school name, city and state)  ____________________________________

 

_________________________________________________________________________________________

 

Where have you attended College? _____________________________________________________________

 

Extra-curricular activities while in High School/college: ____________________________________________

 

_________________________________________________________________________________________

 

_________________________________________________________________________________________

 

_________________________________________________________________________________________

 

Honors received in High School/college:_________________________________________________________

 

_________________________________________________________________________________________

 

_________________________________________________________________________________________

 

_________________________________________________________________________________________

 

List the name, address and occupation of 3 personal references who are NOT relatives or students:

Name                                                              Address                                              Occupation

 

_________________________________________________________________________________________

 

_________________________________________________________________________________________

 

_________________________________________________________________________________________

 

Please attach the following items to this application:

1.              A personal letter explaining your need for a scholarship.

2.              Your High School transcript and College transcript, if applicable.

3.              One (1) letter from a high school teacher and two (2) letters from individuals (not relatives) about your character and your financial need.

4.              A list of any relatives who attended Edmond High School or Edmond Memorial High

5.              You may also provide a list of other relevant information or a resume if you have one, but all questions on this form must be answered on the form.

 

DEADLINE for applications is:    August 15, 2004

Mail application and attachments to:       Gary Canan

                                                                        EHS Scholarship

                                                                        420 S.W. 65th Street

Oklahoma City, OK  73139-7014