The Elizabeth City Foundation

Ray S. Jones Scholarship

Administered by The Elizabeth City Foundation Elizabeth City, North Carolina

The Ray S. Jones Scholarship is awarded annually and

is available to students that meet the following criteria:

 Must be a permanent resident of Camden or Pasquotank County

 Must attend Wake Forest University, the University of North Carolina at Chapel Hill or North Carolina State University as a full-time student

 Must exhibit financial need

 May be renewed if adequate progress is being made in a degree program with a minimum of a 2.0 GPA

Completed Applications must be delivered to Wells Fargo Bank, 400 East Main Street, Elizabeth City, NC by 5:00 pm on March 1st Ray S. Jones Scholarship Application

Administered by the Elizabeth City Foundation Wells Fargo Bank, Trustee ______-______-______Social Security Number

1. Applicant Name ______Last First Middle

2. Mailing Address ______PO Box or Street City State Zip Code

3. Telephone Number ______Date of Birth ______

4. County of Residence ______How long ______U.S. Citizen ? ______

5. Father’s Name ______Last First Middle If living, address ______PO Box or Street City State Zip Code

6. Mother’s Name ______Last First Middle If living, address ______PO Box or Street City State Zip Code

7. Are parents divorced ? ( ) Yes ( ) No Separated ? ( ) Yes ( ) No

8. If you have a guardian, other than a parent fill out the following:

Name and relationship to you ______

Address ______

9. List activities in which you have participated which have been meaningful to you, using additional page if necessary. ______

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10. List offices to which you have been elected in any organizations.

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11. List honors (scholastic, citizenships, etc.) which have been awarded to you.

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Confidential Information

1. Occupation of father or male guardian ______

2. Occupation of mother or female guardian ______

3. Last year’s salary (before taxes) of:

Father: $ ______Other Income $ ______

Mother: $ ______Other Income $ ______

4. Is home owned? ______Existing unpaid mortgage? ______If so, give amount $ ______

5. Approximate value of all parents’ real estate $ ______Parents’ other property $ ______

6. Number of brothers ______Ages ______Number of Sisters ______Ages ______

7. How many brothers ( ) and sisters ( ) will be in college next fall?

8. Including yourself, how many children are dependent on your parents for support? ______

9. List others (and their relationship to your parents) who are dependent on your parents for support.

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10. List outstanding indebtedness (loans, etc.) and/or unusual financial obligations not evident from the above information. ______

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11. Do you have an income (part-time, summer work, etc.)? ______If so, give source and amount of income. ______

12. Which of the following schools do you plan to attend next year? Wake Forest University ( ) University of North Carolina at Chapel Hill ( ) North Carolina State University ( )

13. Have you applied for admission? ______Been accepted? ______If so, attach a copy of your admission letter.

14. What do you expect your education next year to cost? $ ______How much of this amount

will be available from these sources? Other Scholarships $ ______Parents $ ______

Your Earnings $ ______Other $ ______Additional Data

This application will be reviewed and considered on the basis of financial need. It will be to your advantage to emphasize below any facts which you believe entitle you to favorable consideration on the basis of financial need, if such facts are not fully reflected in your answers to specific questions elsewhere in this application.

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