Optimist Club of Senoia

OPTIMIST CLUB OF SENOIA Post Office Box 56 “Friend of Youth” Senoia, Georgia 30276-0056 Club No. 21-267

Jim Nations Scholarship

THE JIM NATIONS SCHOLARSHIP is sponsored by the Optimist Club of Senoia, in memory of Jim Nations who was one of its charter members, and who contributed his time and efforts to the club and to his community.

This award is intended for a student who is going to pursue his or her education by attending a vocational school, and is specifically intended to help defray some part of the cost of such an education.

Selection of the recipient for this award is based on need for financial assistance, and on the recipient’s commitment to complete the chosen course of study.

Applicants need to complete this form and return it to the East Coweta High School Guidance office by the designated date.

NAME______TELEPHONE______

ADDRESS______

PARENT’S NAME______

NAME OF SCHOOL TO ATTEND______

STATE COURSE OF STUDY AND REASON FOR CHOICE______

______

Please attach a recommendation by a member of this community, other than family, endorsing this application. PARENT’S CONFIDENTIAL STATEMENT

Income Information

For both the past calendar year and the current calendar year, please indicate the following:

Parent/Guardian Past Year (Actual) Current Year (Estimate)

Father’s Gross Income ______

Mother’s Gross Income ______

Student’s Gross Income ______

Other Net Income of Family ______

Total Income ______

Total Family Savings over $500______

Total number of family members, including applicant still under the support of the family______.

Total number of family members enrolled full-time in post-secondary school:

Current year ______

Next year ______

Additional Comments of Unusual Circumstances:

______