<p> APPLICATION FOR SCHOLARSHIP AID Please answer every question legibly and fully. If there is information about you or your family which would be important for the committee to consider that is not covered by this questionnaire please include on a separate piece of paper. Completed applications and recommendations should be returned to the Brick Presbyterian Church, 62 East 92nd Street, New York, NY 10128, attention Carol Ann Mercer by May 5, 2014 Date: ______PERSONAL</p><p>Name: ______Date of Birth:______Sex: ____</p><p>Address: ______Telephone: ______(number, street, apt) ______(city) (state) (zip) Father’s Name: ______Living or Deceased:______</p><p>Address: ______(number, street, apt) (city) (state) (zip)</p><p>Mother’s Name: ______Living or Deceased:______(number, street, apt) (city) (state) (zip)</p><p>Brothers and Sisters ______</p><p>Ages ______</p><p>CHURCH AFFILIATION Member of what church? ______</p><p>If not a member of The Brick Church, are you involved in any Brick Church programs, employed by Brick Church, or related in any other way? Please note how long you have had this relationship with the Church.</p><p>______</p><p>______</p><p>Although not required, you may include a letter of reference from a program leader or other individuals you may have worked with at Brick Church. ACADEMIC</p><p>Name of school currently attending: ______Grade: ____</p><p>Address of school: ______</p><p>How long have you attended this school?______</p><p>What school did you attend before? ______</p><p>Academic honors at school: ______</p><p>Extra-curricular interests: ______</p><p>______</p><p>______</p><p>Employment while in school: ______</p><p>______</p><p>Please attach transcripts of grades, testing scores, and one letter of recommendation from the school principal, guidance advisor, or an interested teacher.</p><p>FINANCIAL (CONFIDENTIAL)</p><p>Father’s occupation: ______</p><p>Father’s current employer: ______(name of company) (address)</p><p>Length of employment: ______Prior employer if less than two years:______</p><p>Father’s yearly income: Salary: ______Bonuses: ______</p><p>All other income: Dividends: ______Interest: ______</p><p>Soc. Security: ______Pension: ______</p><p>Welfare: ______Veteran’s Benefits: ______</p><p>Other: ______Total: ______</p><p>Other assets: Apartment: ______Car: ______</p><p>Second home: ______Other: ______Mother’s Occupation: ______</p><p>Mother’s current employer: ______(name of company) (address)</p><p>Length of employment: ______Prior employer if less than two years:______</p><p>Mother’s yearly income: Salary: ______Bonuses: ______</p><p>All other income: Dividends: ______Interest: ______</p><p>Soc. Security: ______Pension: ______</p><p>Welfare: ______Veteran’s Benefits: ______</p><p>Other: ______Total: ______</p><p>Other assets: Apartment: ______Car: ______</p><p>Second home: ______Other: ______</p><p>EXPENSES Number in household: Children at home and ages: ______</p><p>Elderly at home: ______</p><p>Children away at school and ages: ______</p><p>Major medical or dental bills: ______</p><p>SCHOLARSHIP AID Are you currently on scholarship or receiving any financial aid? ______</p><p>From whom, when due, and amount: ______</p><p>______</p><p>Have applied for other scholarship aid? Please describe: ______</p><p>______</p><p>______Have you worked during the school year and/or in the summer to earn money for your education? </p><p>Please describe all jobs: ______</p><p>______</p><p>______</p><p>Please list anticipated expenses for the year and itemize (room, board, tuition, books, etc):</p><p>______</p><p>______</p><p>______</p><p>What degree or certificate will you be working on during the coming school year?</p><p>______</p><p>Colleges or schools applied to:</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p>