<p>Knights of Columbus Christ the King Council 7196 210 E 24th Ave Belton, Texas 76513</p><p>2017 Alan R. Beach Memorial Scholarship Application</p><p>Deadline: Friday, June 9th, 2017</p><p>Date:______, 2017 ______Signature of Student</p><p>STUDENT’S FULL NAME: MR/MS______</p><p>STUDENT’S ADDRESS: ______</p><p>______</p><p>Parents Phone Number ______</p><p>FATHER’S NAME______OCCUPATION______</p><p>MOTHER’S NAME: ______OCCUPATION______</p><p>NUMBER OF DEPENDENT CHILDREN IN FAMILY OTHER THAN YOU____</p><p>ANNUAL GROSS INCOME OF FAMILY (CIRCLE ONE) $ 0-$10,000 $50,001 - $60,000 $10,001- $20,000 $60.001 - $70.000 $20,001- $30,000 $70,001 - $80,000 $30,001- $40,000 $80,001 - $90,000 $40,001- $50,000 $90,001 – up</p><p>HIGH SCHOOL CURRENTLY ATTENDING: ______</p><p>CURRENT NUMERICAL GRADE AVERAGE FOR HIGH SCHOOL WORK: ______(ON 100 POINT-4.0 SCALE)</p><p>PROVIDE TRANSCRIPT OR INFORMATION ON LETTERHEAD SIGNED BY SCHOOL OFFICIAL</p><p>LIST OF ACTIVITIES IN WHICH YOU PARTICIPATED IN SCHOOL, CHURCH, & COMMUNITY:</p><p>1______5______</p><p>2______6______</p><p>3______7______</p><p>4______8______</p><p>SIGNATURE OF RELIGIOUS EDUCATION DIRECTOR: ______</p><p>SIGNATURE OF C.Y.M. DIRECTOR: ______DO YOU INTEND TO COMPLETE COLLEGE IF YOU HAVE THE MEANS? YES____ NO____</p><p>LIST THREE CHARACTER REFERENCES WHO ARE NOT RELATED TO YOU: NAME ADDRESS PHONE</p><p>IN 100 WORDS OR LESS, EXPLAIN WHY YOU FEEL YOU ARE DESERVING OF THE ALAN R. BEACH MEMORIAL SCHOLARSHIP AWARD. INCLUDING ANY INFORMATION PERTAINING TO THE BEFORE MENTIONED CRITERIA. (ATTACH VERIFICATION DOCUMENTATION) 1. ACADEMIC: Overall numerical grade (based on 100 point 4.0 scale) as provided by the school official.</p><p>2. RELIGION: Applicant to be evaluated by D.R.E. and C.Y.M. Directors and to be placed in First, Second, and Third place. Specific criteria to be determined by D.R.E. and C.Y.M. directors, although general Church and Parish Ministries participation will be overall theme.</p><p>3. LEADERSHIP: The Council 7196 selection committee will evaluate candidates on the leader- ship potential that they have exhibited by considering the following: (1) Leader- ship positions that candidates may have served in within any ministry, club, organization, or committee. (2) Any awards that the candidates may have received for serving in a leadership role within any ministry, club, organization, or committee. (3) Any awards, or special designations for attaining levels of excellence within any ministry, club, organization, or committee.</p><p>4. FINANCIAL NEED: Candidates will be evaluated on basic financial need by comparing the gross personal income of both parents. The least amount of total income will be awarded first place, etc. Candidates must supply either a current W-2 form from each parent or a copy of the parent’s most recent federal income tax return Form 1040, 1040A, or 1040EZ. </p><p>GENERAL INFORMATION</p><p>1. Two $1,000 Scholarships will be awarded to the candidates with the most overall points after awarding each place in each respective category. In case of a tie, the scholarship will be awarded to the candidate with the most financial need. Decisions of the Scholarship Committee are final. There are no appeals.</p><p>2. Applicant must be a member of Christ the King Parish of Belton, Texas or the applicant’s father must be a member of Knights of Columbus Christ the King Council 7196 of Belton, Texas.</p><p>3. Applications received after 5:00 PM, Friday, June 9 th 2017, will NOT be considered. Applications can be turned in to the Christ The King Church office.</p><p>4. Failure to answer any question(s) may disqualify the applicant from consideration.</p><p>5. Any false statements found on the applications will disqualify the applicant.</p><p>6. Applicants should make a photocopy of their completed application for their personal records.</p><p>7. Upon receipt of “Verification of Enrollment” from the proper school officials, a check will be forwarded to the College or University to establish a credit for the awarded student.</p><p>8. If awarded student’s conduct is found to be contrary to the principals of law, order, and morality supported by the Knights of Columbus, unexpended credit is subject to withdrawal. </p>