<p> STUDENTS WITHOUT MOTHERS SCHOLARSHIP APPLICATION</p><p>Applications are accepted from September 1st through December 31st each year from current high school seniors. Scholarships are generally $4,000 per student, disbursed in annual payments of $1,000. Students must continue to meet the criteria of the program to receive annual disbursements. Program details, including renewal requirements, are available on the website www.studentswithoutmothers.org. </p><p>The number of scholarships awarded are determined by the amount of funds available each year. To apply please complete the application below and write a 250-word essay (including hobbies/interests, hardships, future plans and why you should be awarded a scholarship). INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. Mail your complete application and essay to: Students Without Mothers, Inc., 4500 Hugh Howell Rd., Suite 790 Tucker, GA 30084. </p><p>SUPPLEMENTAL SCHOLARSHIP: Each year one applicant is selected to receive a supplemental scholarship for community service work. If you wish to be considered for this supplemental scholarship, please complete and return the Community Service Form (available on the website) along with the regular scholarship application and essay. The application for the supplemental scholarship is optional and not required to receive the main scholarship.</p><p>Date: ______</p><p>Applicants Name: ______Gender: (M) ______(F) ______</p><p>Date of Birth: ______Home Phone: ______Mobile: ______</p><p>Email: ______County of Legal Residence: ______</p><p>Mailing Address: ______</p><p>City, State, & Zip Code: ______</p><p>Name and phone number of a friend or relative not living with you: </p><p>______</p><p>High School Currently Attending: ______</p><p>Month/Year Expected to Graduate: ______</p><p>Name of College or Institution Planning to Attend: ______</p><p>Intended Major / Course of Study: ______</p><p>Legal Guardian’s Name: ______Relationship: ______</p><p>* Legal Guardian’s Total Gross Income (Annually): ______</p><p>Do you live with your legal guardian? ______</p><p>If not, with whom do you live? ______Relationship: ______</p><p>My mother is absent due to: Death ______Other Reason ______</p><p>______Student’s Signature</p><p>* Proof of income documents may be requested.</p><p>Revised June 23, 2009</p>