Mitchell Historical Society High School Scholarship Application

Applicant Information:

First Name

Middle Name

Last Name

Address

City/State/Zip

County of residence

Father’s Information:

Father’s name Place of employment Address

Mother’s Information:

Mother’s name Place of employment Address Family Information: Please list the family members living in your primary residence (ex, father, mother, brother, sister, grandparent) Number of siblings already in college College Information

Please list your top three choices of colleges to which you have applied.

Please List all colleges where you have been accepted.

Will you live on campus, off campus, or commute from home?

Academic Information Where do you attend school?

What is your class rank? What is your GPA? What are your highest SAT scores? What is you highest ACT composite score? Weighted Unweighted Verbal Math Writing Composite List the high school classes you have taken at and the grades you have made (ex, english I, 96)Freshman Sophomore Junior Senior List any classes and grades you have taken outside of high school (ex. Mayland classes) Freshman: Sophomore: Junior: Senior: References: List one high school teacher and one community member or employer who knows you well. (Please ask the person before using his/her name as a reference. If you are a home school student, use two community members.) Teacher's Name, occupation, phone number, and email. Community member's Name, occupation, phone number, and email ALL ABOUT YOU Answer ONE of the following two prompts. You may use an essay you have already used for other scholarships as long as it answers the prompt completely.

1. What is your passion? Does this influence your future plans? This may be something you enjoy, dislike, feel strongly about, or would like to change.

2. Describe an obstacle or hardship you have overcome. How has it influenced your future plans?

OPTIONAL ESSAYYour choice! This can be a personal statement, essay you have written for class or college application.

PERSONAL, EDUCATIONAL, and CAREER GOALS

Describe your personal educational and career goals. Please indicate the level of your interest in Appalachian Studies including, but not necessarily limited to Appalachian history, music, art, folk culture and economic or community development. Please include your desire, if any, to pursue this study at a higher educational level and to eventually live and work within Appalachia.

FACT SHEET or RESUME Please copy and paste, or list your fact sheet here. (e.g. employment history, volunteer history, and extra curricular activities)

FINANCIAL AID INFORMATION List any scholarships/grants/other aid you have received. List the title, the school, and the amount per year. What is the annual cost of the college you will most likely attend? * *Tuition+housing+food+books. See college website. Name of college Annual cost What is your Estimated Family Contribution? What is your family’s combined total income?

If you have additional financial considerations that need to be considered, you are welcome to share whatever information you wish. CERTIFICATION STATEMENT By completing this document and submitting it for review to a local scholarship donor I certify that its content is entirely my own work (not my parents or friends). I also agree that it is ok to contact the references I have listed. Type your full name if you agree with the certification statement above. * Unsigned applications should not, and will not be considered. Signature: