Named Scholarship Application 2015-2016

SUBMISSION DEADLINE: MONDAY, DECEMBER 1, 2014

Fill in the fields on this form and save it to your computer. Note: If you are unable to enter data into the form fields, download and save the PDF to your computer. Then, open the file and fill out the form. SAVE THE FILE AFTER FILLING OUT THE FORM

Please answer the following as completely as possible to receive full consideration from the Scholarship Committee. (Information requested on Page 2 is optional. If you choose to provide it, please also be thorough in those responses.)

Applicant’s Full Name:

Student ID Number:

Home Address:

City: State: Zip Code:

If you live on campus, what is your complete campus address:

City: State: Zip Code:

Holy Family University E-mail address: (Please note: All official correspondences will come from and will go to this e-mail address)

Home Phone:

Cell Phone:

What semester/year did you start at Holy Family:

Expected Date of Graduation from Holy Family:

Your Major at Holy Family:

Education Majors, please indicate which semester you are scheduled to student-teach:

Please list your current community service activities, starting where you perform them, for whom, and why.

If you are involved in extracurricular activities at Holy Family University, please confirm your participation by having the moderator of each club in which you are involved complete a moderator form (found on page 3 of this application).

Revised 10/2014 2 Please provide a detailed explanation of how you uphold and reflect the mission and core values of Holy Family, both as a student of the University and in the greater community. Mission statement featured: http://www.holyfamily.edu/about-holy-family-u/general-info/mission-values Optional Information (May be used for scholarships with specific qualifying restrictions. If you choose to provide, please be thorough in your responses.)

Date of Birth:

Please indicate your parent’s ethnicity if either German or Polish:

Were you, your parents or grandparents born in another country? Yes No

Are you a citizen of the United States? Yes No

Are you a first generation in your family to attend college? Yes No

Have you or a member of your immediate family been diagnosed with cancer? Yes No Please feel free to explain if you wish:

Name of High School Attended: Graduation Date:

Please state whether you have attended a primary or secondary school staffed by the Sisters of the Holy Family of Nazareth (specify the school name):

Do you have parents who are Holy Family graduates? Please list their names and the year they graduated from Holy Family.

Please share additional information or personal circumstances that you feel is important and would like the Scholarship Committee to know and consider.

By submitting this application BY THE DEADLINE DATE OF MONDAY, DECEMBER 1, 2014, as a Word attachment to an e-mail from your University e-mail account to [email protected], you certify the truthfulness of the information and provide Holy Family University's Institutional Scholarship Selection Committee and other University personnel permission to review your grades, academic standing, records of service and activities, as well as information on file in the Office of Financial Aid.

ALL DECISIONS MADE BY THE INSTITUTIONAL SCHOLARSHIP SELECTION COMMITTEE ARE FINAL AND ARE NOT SUBJECT TO APPEAL.

For writing assistance, please refer to the Center for Academic Enhancement, 267 341-3326

For Printing and/or E-mailing Assistance, please refer to the Help Desk, 267 341-3402

Revised 10/2014 3 Holy Family University does not discriminate on the basis of race, color, gender, age, religion, national or ethnic origin, sexual orientation, marital status, or disability. This policy extends to all Institutionaleducational, Scholarship employment, and service programs at the University and complies with applicable federal laws. For informationSelection regarding Committee compliance matters, the University's ADA/Section 504 and Title IX Compliance Officer may be reached at the Human Resource Department, Holy Family Hall, Room 209, (267) 341-3479.Date:

Club Moderator Form

Name of Student:

Name of Organization:

Dear Faculty/Staff Member:

The student named above has applied for a named scholarship for the 2015-2016 academic year and has noted membership in your organization for the current year on the application form. In order to honestly evaluate the candidate, the Institutional Scholarship Selection Committee would appreciate your help by answering the following questions. Please feel free to add any additional comments.

 Is the student a member in good standing? Yes No How long?  Does this student attend meetings regularly? Yes No  Is the student involved in planning activities? Yes No Name activities:  Does this student support planned activities? Yes No  Does this student hold a leadership position? Yes No Position held:  As a student member, please rate participation? Yes No 1 2 3 4 5 low average high  As a student leader, please rate performance: 1 2 3 4 5 low average high

Club Moderator Name/Signature:

Faculty/Staff member must send this form from their Holy Family email account Revised 10/2014 4 BY MONDAY, DECEMBER 1, 2014 as a Word attachment to an e-mail addressed to: Patti Paluch/ Development Office/ Woodhaven [email protected] 267-341-5005

Revised 10/2014