Campbell County High School Local Scholarship Application

Name ______

Home or Cell phone # ______Grade Point Average ______Address______ACT or SAT Score ______Email address______Approximate class rank ______out of 308

Parent(s) Name(s) ______No. in family presently at home ______How many parents work? ______Parent(s) Employers: ______Estimated family yearly income______*Please include a copy of the page showing adjusted gross income from your family’s 2013 federal income tax form OR your 2016-17 FAFSA Student Aid Report (SAR) showing your Estimated Family Contribution (EFC).

Number of college students in household during the 2104-15 year (include yourself)______List any colleges applied to (limit 3): ______

Future Plans (Institution) Field of Study Career Plans

List extracurricular activities (school, church, community) and/or any work experience. Attach extra sheets, if necessary.

List offices held and honors received during high school. Attach extra sheets, if necessary.

List three (3) names and addresses of personal references (other than family).

On a separate sheet of paper, type an essay (500-750 words) on the following topic: “How certain are you of your future plans, and how has your K-12 education affected your desire to enter a specific career field? Please include information about coursework and/or specific teachers, community members, and others who have affected your desire to learn more about this field.” THIS APPLICATION IS DUE TO KATHERINE AYERS NO LATER THAN MARCH 18, 2016