<p>OPTIMIST CLUB OF SENOIA Post Office Box 56 “Friend of Youth” Senoia, Georgia 30276-0056 Club No. 21-267</p><p>Jim Nations Scholarship</p><p>THE JIM NATIONS SCHOLARSHIP is sponsored by the Optimist Club of Senoia, in memory of Jim Nations who was one of its charter members, and who contributed his time and efforts to the club and to his community.</p><p>This award is intended for a student who is going to pursue his or her education by attending a vocational school, and is specifically intended to help defray some part of the cost of such an education.</p><p>Selection of the recipient for this award is based on need for financial assistance, and on the recipient’s commitment to complete the chosen course of study.</p><p>Applicants need to complete this form and return it to the East Coweta High School Guidance office by the designated date.</p><p>NAME______TELEPHONE______</p><p>ADDRESS______</p><p>PARENT’S NAME______</p><p>NAME OF SCHOOL TO ATTEND______</p><p>STATE COURSE OF STUDY AND REASON FOR CHOICE______</p><p>______</p><p>______</p><p>Please attach a recommendation by a member of this community, other than family, endorsing this application. PARENT’S CONFIDENTIAL STATEMENT</p><p>Income Information</p><p>For both the past calendar year and the current calendar year, please indicate the following:</p><p>Parent/Guardian Past Year (Actual) Current Year (Estimate)</p><p>Father’s Gross Income ______</p><p>Mother’s Gross Income ______</p><p>Student’s Gross Income ______</p><p>Other Net Income of Family ______</p><p>Total Income ______</p><p>Total Family Savings over $500______</p><p>Total number of family members, including applicant still under the support of the family______.</p><p>Total number of family members enrolled full-time in post-secondary school:</p><p>Current year ______</p><p>Next year ______</p><p>Additional Comments of Unusual Circumstances:</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p>