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Scholarship Application 09 Correct

This document is a scholarship application for Delegate Wayne Norman's House of Delegates Scholarship. It requests personal information such as name, address, parents' occupation and income, as well as academic information including SAT/ACT scores, GPA, extracurricular activities, career goals, and a 300-400 word essay. Applicants must submit an official transcript and any other supporting documents along with the completed application by April 1st, 2009 for consideration.

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88 views

Scholarship Application 09 Correct

This document is a scholarship application for Delegate Wayne Norman's House of Delegates Scholarship. It requests personal information such as name, address, parents' occupation and income, as well as academic information including SAT/ACT scores, GPA, extracurricular activities, career goals, and a 300-400 word essay. Applicants must submit an official transcript and any other supporting documents along with the completed application by April 1st, 2009 for consideration.

Uploaded by

brianyoung2074
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF or read online on Scribd
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House of Delegates Scholarship Application

DELEGATE WAYNE NORMAN


Annapolis Office Phone: (410) 841-3284

Please complete the following form and return to Delegate H. Wayne Norman. at: Check box if this is
P.O. Box 173, Jarrettsville, MD 21084 by April 1st, 2009. a renewal application.
NAME OF APPLICANT (Please type or print legibly.) SEX

(L) (F) (M.I) ______ M ______ F


SOCIAL SECURITY NUMBER DATE OF BIRTH PHONE

/ /
HOME ADDRESS CITY ZIP CODE

SECTION I FATHER (OR GUARDIAN) NAME MOTHER (OR GUARDIAN) NAME

PERSONAL FATHER (OR GUARDIAN) OCCUPATION AND EMPLOYER MOTHER (OR GUARDIAN) OCCUPATION AND EMPLOYER

INFORMATION
YOUR MARITAL STATUS COLLEGE ATTENDANCE PLANS

_____ Married _____ Divorced _____ Single


_____ Full-time Student _____ Part-time Student
Do you have any dependents? Yes _____ No _____ If yes, how many? ______

Do your parents have any additional dependents? Yes _____ No _____ _____ Undergraduate _____ Graduate

If yes, how many? ______

Total Family Income


(Salaries, Interest, Dividends as reported to IRS): $ _______________________
SECTION II STUDENT FUNDS AVAILABLE

FINANCIAL
Scholarships: $ _______________ Full-time job: $ _______________
INFORMATION
Savings: $ _______________ Part-time job: $ _______________
Loans: $ _______________ Other: $ _______________
NAME OF SCHOOL YOU WILL ATTEND CITY & STATE OF SCHOOL

NAME OF HIGH SCHOOL YEAR GRADUATED

CURRENT G.P.A. CLASS RANK: OUT OF:

SECTION III
MATH S.A.T./A.C.T SCORE VERBAL S.A.T/A.C.T SCORE DATE OF S.A.T./A.C.T

ACADEMIC EXTRACURRICULAR ACTIVITIES, COMMUNITY SERVICE, AND EMPLOYMENT (Use back of application form if needed.)
INFORMATION

CAREER GOALS

PLEASE ENCLOSE A 300 – 400 WORD ESSAY EXPLAINING HOW THIS SCHOLARSHIP WILL HELP YOU ACHIEVE YOUR
GOALS, AN OFFICIAL TRANSCRIPT OF YOUR GRADES AND ANY OTHER HELPFUL INFORMATION.
CERTIFICATION: All information on this form is true and complete to the best of my knowledge. If asked by an authorized official, I
agree to give proof of the above information. I realize this proof may include a copy of U.S., state, or local income tax returns. I agree that if
I do not furnish proof of the above information upon request, student aid may not be received.

__________________________________________ ___________________________________
STUDENT SIGNATURE PARENT OR SPOUSE SIGNATURE

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