Woodmen of the World Lodge 323

DAVIE COUNTY EXTENSION & COMMUNITY ASSOCIATION SCHOLARSHIP FOR HIGHER EDUCATION

The members of the Davie County Extension & Community Association will present a $400 higher education scholarship to a Davie County Senior Graduate (Davie High School, Early College, Homeschool) who needs financial aid to enable them to continue their education at a higher education institution. Awarding of these scholarships will be based on financial need, determination, and scholastic ability. You will need to give permission for a transcript of your grades to be attached to this application for it to be considered.

The $400 will be paid directly to the College or Technical School of the students’ choice to be applied toward tuition and books. This $400 will be available solely for the furtherance of the students’ education, and not transferable for any other purpose. If not used in its entirety by the recipient, the College or Technical School shall refund any unused balance to: Davie County ECA Treasurer, 1582 Davie Academy Rd., Mocksville, NC. 27028.

All required information shall be confidential, and will only be used as a means of awarding the scholarships.

An appointed committee of three (3) Davie ECA members will review applications. Chosen applicants will be interviewed March 20, 2014. An ECA member will contact applicant to set up interview time. Mail application by March 3, 2014 to: Mary Nell Richie, 351 Richie Road, Mocksville, NC 27028

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Full name:______First Middle Last

Home Address:______Street / Road (Mailing address also if P.O.Box is used)

______Telephone No.: ______City, State and Zip

Date of Birth:______Single:______Married:______

Father’s Name and Address:______

Father’s Occupation:______

Mother’s Name and Address:______

Mother’s Occupation:______

Number of Brothers:______Ages:______School level of each ______

of Sisters: ______Ages: ______School level of each :______

List all Schools that you have attended with dates:______

______

1 Intended College/Technical School: ______Have you been accepted? ______Yes ______No

Intended Major: ______

Career Objective: ______

Give approximate fees for one year at your chosen College/Technical School: ______

Have you applied for Financial Aid at the School of your choice: ______Assured of receiving any? ______

Have you applied for additional scholarships? ______Assured of receiving any? ______If yes, list the amount: ______

Have you been employed for pay during the past year? ______If yes, where?______

Will you be willing to work part time to further your education? ______

FINANCIAL INFORMATION: Do your parent/s own property? ______Approximate value: ______

What were your parents approximate combined income before taxes last year? (Include taxable and nontaxable income from all sources) Check one: ( ) Less than $10,000 ( ) $10,000 to $30,000 ( ) $30,000 to $50,000 ( ) $50,000 to $70,000 ( ) More than $70,000

RECORD OF ACTIVITIES AND HONORS: [If possible please use space provided, or reverse side rather than attachments.] Activities in High School, Community, or Church which have been meaningful to you:______Honors (scholastic, citizenship etc.) and special achievements: ______Offices or positions in which you have served (School, Community, Church, Other: ______

2 High School Grade Average: ______

Hobbies and special interest: ______LIST THREE CHARACTER REFERENCES...with complete address and telephone number: 1) ______

2) ______

3) ______APPLICANTS STATEMENT: [Please limit to space provided.] (Please make a personal statement about yourself, expressing your desires, ambitions, and educational goals.)

3 IMPORTANT: Review this form and make certain that you have responded accurately to all questions. CERTIFICATION: I, ______hereby declare that, to the best of Signature of Parent (or major supporter) my knowledge, the foregoing statements are complete and correct, and I approve ______’s application for this scholarship.

______Date: ______Signature of Applicant