Kitas and Lutsko Family Foundation Scholarship Award Application

Kitas and Lutsko Family Foundation Scholarship Award Application 2015 - 2016

The Kitas and Lutsko Family Foundation provides scholarship funds to talented students who need financial assistance to attend a two-year or four-year college located in the Roanoke Valley region of Virginia. These colleges include: 1) Jefferson College of Health Sciences, Roanoke, Virginia and 2) National College, Salem, Virginia. Students must be U. S. citizens and must be enrolled, or planning to enroll full-time, in either the technical (Computer Science, Information Systems Technology and Engineering) or health care related field of study. Scholarship awards will be based primarily on academic achievement and demonstrated financial need. Scholarship amounts will vary but will generally be in the $2000.00 range. (Members of the Kitas and Lutsko families are not eligible for this scholarship).

INSTRUCTIONS: Read and answer every question. Please, write ‘N/A’ for those items not applicable. This is an annual award and applicants must submit a new application each year. The recipient is responsible for determining if any portion of the scholarship is subject to income tax. Award amounts vary based upon need.

Your application for the 2015-2016 academic year MUST be received in the Office of Financial Aid no later than April 10, 2015 no exceptions. Any application received after this date will not be considered. Applicants may be interviewed as part of the decision process.

Please return completed applications to:

JEFFERSON COLLEGE OF HEALTH SCIENCES OFFICE OF FINANCIAL AID 101 ELM AVENUE SE ROANOKE VA 24013-2222

A Complete Application Packet consists of the following:

____Completed Application (Pages 1-2) ____Typed Summary. Completed on a separate “8 ½ x 11” sheet of paper. ____Unofficial H.S. Transcript, or Copy of G.E.D. ____Unofficial College Transcript (if applicable) ____Three (3) letters of reference, at least Two (2) of which must be from School Officials. ____A copy of your Federal Tax Return or IRS Tax Transcript. If a Dependent, a copy of your Parents’ Federal Tax Return or IRS Tax Transcript OR your Student Aid Report (SAR; the results of your FAFSA application) if Federal Tax Returns have not been filed.

Recipients will be notified by: June 12, 2015. Kitas and Lutsko Family Foundation Scholarship Award Application 2015 - 2016

The Kitas and Lutsko Family Foundation provides scholarship funds to talented students who need financial assistance to attend a two-year or four-year college located in the Roanoke Valley region of Virginia. These colleges include:1) Jefferson College of Health Sciences, Roanoke, Virginia and 2) National College, Salem, Virginia. Students must be U. S. citizens and must be enrolled, or planning to enroll full-time, in either the technical (Computer Science, Information Systems Technology and Engineering) or health care related field of study. Scholarship awards will be based primarily on academic achievement and demonstrated financial need. Scholarship amounts will vary but will generally be in the $2000.00 range. (Members of the Kitas and Lutsko families are not eligible for this scholarship).

Personal Information

Name: Date:

Address:

Telephone No.:

E-Mail Address:

Virginia resident for ______years.

Educational Background

Academic Classification (check one):

High School Senior: GED Equivalent: College (year):

High School attended:

College attended:

Scholastic Information:

Name of College you plan to attend:

Date of enrollment: Expected graduation date:

Degree desired: Academic major:

Grade Point Average: High School Soph: Junior: Senior:

Grade Point Average: College: Page 1 of 2 Kitas and Lutsko Family Foundation Scholarship Award Application 2015 - 2016

Financial Aid:

Have you submitted a financial aid application to your institution for the coming year?

Yes: No:

List other scholarships and other financial assistance received as of this date:

List other scholarships and other financial assistance expected as of this date:

Please describe your financial need:

Request for Additional Information:

1. Please provide a typed summary (no longer than one page) which includes, and is organized by, high school extracurricular contributions, work experience, community volunteer contributions and career aspirations.

2. High School Transcript or copy of GED Certificate, as applicable

3. College Transcript, if applicable.

4. Copy of SAT, PSAT scores, if applicable.

5. Three (3) Letters of Reference, at least Two (2) of which must be from School Officials.

6. A copy of the most recent Federal Income Tax Return filed by your Parents, as well as your own (DO NOT INCLUDE W-2’S OR SCHEDULES), or your Student Aid Report (SAR) from FAFSA if Federal Tax Returns have not been filed.

Application submission:

Submit application to the identified office for your respective college.

of 2 STUDENT PERMISSION TO RELEASE INFORMATION

I, ______, give my permission (Print Name Here) to disclose information in my educational record at JCHS to the Kitas and Lutsko Family Foundation.

The records which may be disclosed to the above-named foundation for the purpose of their review includes the following items:

 Academic Standing/Grades/ /GPA  Attendance and Enrollment  Financial Aid Information and Financial Standing  Completion of studies/graduation

This release will be in effect for all periods of my enrollment at JCHS upon acceptance of a Kitas and Lutsko Family Foundation scholarship.

Student Signature ______Date ______

Rev. 08 02/05/2015