2010 Scholarship Application
Deadline Monday, March 22, 2010

By completing this application you will be considered for all Greater Worcester Community Foundation scholarships for which you are eligible. If you have any questions about your eligibility, please contact the Scholarship Office at (508) 755-0980 or by email at scholar@greaterworcester.org. Please use Internet Explorer as your web browser to complete this form.

You will be notified of your application status by the end of June 2010. Due to the large number of students seeking scholarships, late or incomplete applications will not be considered.

APPLICANT INFORMATION
Student First Name MI Last Name
Home Address Apt. #
City

State Zip

Email

Phone

 Home format: xxx-xxx-xxxx Cell
Birth Date format: mm/dd/yyyy
HIGH SCHOOL AND ACADEMIC INFORMATION
High School, GED, or Home School

 

If your high school is not listed above, please enter name here
Date of Completion format: mm/yyyy
Current GPA 4.00 format: x.xx   SAT: Math Critical Reading Writing

I am a member of National Honor Society


COLLEGE

 

Name of your top three Colleges or Schools you are considering for enrollment in Fall 2010

 
First Choice
Second Choice
Third Choice
Expected college major or course of study
Type of degree
Do you plan to live
Will you attend
Year of study
   
FINANCIAL INFORMATION

I. College Costs and Resources for 2010-2011

A. Estimated total tuition, room and board for college.

(exclude books and personal expenses)

$
B. Amount your family will contribute toward these expenses. $
C. Amount that you personally can contribute, including summer earnings and employment during the academic year.
$
Total Resources (Line B + Line C) $
   

II. Annual Family Income and Assets    
The information below will only be viewed by scholarship personnel in the Foundation office
Are you a dependent student?
A. If dependent, parent/guardian please submit the following data
Parent/guardian name  
Occupation
Annual income
$
Parent/guardian name    
Occupation
Annual income $
Other income (alimony, child support, unemployment, other)          Other income $
Total cash, savings, cash value of stock or other investments   $
Family medical/dental expenses not paid by insurance   $
       
B. If independent, applicant please provide the following
Applicant occupation Annual income $
Spouse occupation Annual income $
Other income (alimony, child support, unemployment, other)          Other income $
Total cash, savings, cash value of stock or other investments   $
Family medical/dental expenses not paid by insurance   $
     
C. For all applicants    
Total number of family members living in your household  
Total number of children living at home, including the applicant  
Total number of family members, including the applicant, to be enrolled in college in 2010  
III. Other Scholarships
Please list other scholarships you are seeking or have been awarded:
Scholarship(s) Amount Granted Pending
$
$
$
IV. Free Application for Federal Student Aid (FAFSA)
If you haven't already applied, visit http://www.fafsa.ed.gov    
Answer A or B below:    
A. Estimated Family Contribution (EFC) from the FAFSA
 
B. I will not apply for financial aid through the FAFSA    
SCHOLARSHIP ELIGIBILITY
Instructions: Please check the following if you wish to be considered for any of our scholarships with specific criteria
My Background
My ethnic background is:
African-American
Hispanic/Latino
Finnish
Lithuanian
Scandinavian
Other:

I am a "non-traditional" student (i.e. GED, home schooled, resuming education after interruption)

I am physically or mentally disabled
My parents did not attend college
I have experienced the death/disability of a parent (include special circumstances statement)
I am Roman Catholic
I am Jewish
I am a resident of Lincoln Village in Worcester
Elementary/High School
Attended Grafton Street School for at least one year
Attended Auburn High School for at least three years
Attended Elm Park Community School for at least two years
Attended Charlton Public School for at least five years
Attended Belmont Street School for at least one year - must have attended for 6th grade
Attended Sutton public school for at least two years
Participated in AVID Program at North High School for four years
Community Involvement - I have actively participated in, volunteered at, or been employed at:
Friendly House
Boys & Girls Club of Worcester
Girls, Incorporated
Worcester Youth Center
Why Me, Inc.
A GWCF 2009 Grantee Agency - Specify Agency:
I volunteer hours a week, on average, through school, church, or community
I am a member of Congregation B'nai Shalom in Westborough
I am a member of Holy Angels Parish in Upton
I am a member of St. Luke the Evangelist Church in Westborough
Affiliations - Where indicated, please provide name of associated family member
I am the child of a past or present member of the Worcester Rugby Football Club - Specify Member Name:
I am the child of a past or present Worcester Fire Fighter or Police Officer - Specify Member Name:
I am the child of and currently reside with an employee of Cutler Associates, Inc. - Specify Employee Name:
I am the child of an employee of The Feingold Companies - Specify Employee Name:
I am the child of an employee of Rotman's Furniture/Murida Furniture Company - Specify Employee Name:
I am a relative of a member in good standing of the Fitchburg Sportsmen's Club - Specify Member's Name:
I am an employee or family member of a current Webster Square Business Association member business - Specify Name of Business: Specify Employee Name:
Athletics
I have played on a softball team - Specify Team Name:
I have played varsity ice hockey at Wachusett Regional High School
Area of Study - I plan to concentrate in:
Art/Architecture, Landscape Architecture/Horticulture
Athletics/Physical Education/Sports Management
Business/Public Service
Commercial Art/Graphic Design - Submit 5-7 examples of recent art work on CD
Computer Science/Information Technology
Criminal Justice Field
Engineering
Health Field
History, Political Science or Economics
Instrumental Classical Music
Jazz Music - Include an additional recommendaiton from a jazz teacher
Journalism
Mathematics
Teaching
College Experience
I've completed community college and will be enrolling in a four year college to complete my Bachelor's Degree
  Dates of enrollment:
  (mm/yyyy) to (mm/yyyy)
  College Name:
 
CERTIFICATION

Applicant

By checking the box at left, I certify that I am a legal resident of the Commonwealth of Massachusetts and that all information on this form is true and complete to the best of my knowledge. If requested, I agree to give proof of the information I have given on this application and supporting materials.

I also hereby authorize the college or institution I attend in the 2010-2011 academic year to release information on financial aid awarded to me by the institution and other sources to Greater Worcester Community Foundation. I agree that my name can be used in announcements made by the Foundation regarding any scholarship I may be awarded.

 

Parent/Guardian:

By checking the box at left, I certify that the information provided is true and complete to the best of my knowledge. If requested, I agree to provide proof of the information provided on this application.
DEADLINE MARCH 22, 2010 BY 5:00 PM
To complete your application, you must submit the following materials to the Foundation by the deadline:
___ Official transcript from your most recent high school, college or GED scores
___ One-page personal essay describing your academic and career goals, interests and achievements. Essay must be typed.
___ Resume listing extra-curricular activities (e.g. student government, music, art, sports, clubs) including community work, volunteer and paid work experience, academic honrs, awards or achievements along with years of participation. Resume must be typed.
___ Letter of recommendation addressed to Ann T. Lisi and written by an adult (not related to you) who can best describe your abilities and accomplishments. The recommendation should focus on your academics, activities, character and your ability to succeed in college.
___ Unusual factors Are there any family or personal circumstances that you feel should be taken into consideration by the Scholarship Committee? If yes, please send a separate statement describing the situation.
___ Any additional materials required by specific scholarship(s) for which you wish to be considered.
 

*****STOP. Please read note before continuing.*****

Please check your responses before submitting your application. When you click on the "Submit" button below, another screen will appear showing the data you have entered. If you have provided an email address in the application, a confirmation of your data will also be sent to you via email.