The Griswold Family Association of America, Inc. 2012 APPLICATION GRISWOLD FAMILY ASSOCIATION SCHOLARSHIP
Name of GFA member: must be applicant or applicant’s parent
_______________________________________________________________________________ Griswold Line, if known (please circle one): Edward Michael Matthew Francis
APPLICANT INFORMATION: (Please print legibly)
Name _______________________________SSN or student number______________ Last First M.I.
Home Mailing Address __________________________________________________________
Home Phone ( )____________ Date of Birth _____E-mail address______________
Father or Guardian Name ________________________________________________________
Mother or Guardian Name _______________________________________________________
1. U. S. Citizen? Yes _______ No __________
2. High School(s) Attended? ______________________________________________________ ______________________________________________________
3. High School Graduation Date ____________________
4. Institution of higher learning to which applicant's scholarship award is requested (if known; we recognize that some have college applications pending on admission results): Institution Location Major ______________________________________________________________________
5. Will you commute from home? ___ Live on Campus? ___ Off-campus apartment?________
6. Parent's or Guardian's occupation: Occupation Employer
Father ___________________ __________________________________________
Relationship Age Status (Employed-student-etc.) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _______________________________________________________________________________
8. Other scholarships, grants, loans, etc. you are seeking or have received: Source Amount Sought Amount Received _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
PLEASE COMPLETE IN DETAIL THE FOLLOWING QUESTIONS. ATTACH ADDITIONAL SHEETS OF PAPER FOR COMPLETE ANSWERS AND IDENTIFY WITH APPROPRIATE LETTERS:
A. Describe your work experience, indicating period of time in each job, rates of pay, and duties/responsibilities.
B. List your memberships and participation in school and community organizations and activities.
C. Prepare a statement of your aspirations, and give other information you feel will help the award selection committee.
D. Indicate unusual family or personal circumstances, if any, which you feel warrant the attention of the award selection committee.
I hereby give permission to my high school to release a copy of my transcripts of grades, class rank, college board scores. I further certify that the information contained in this application is complete and accurate, to the best of my knowledge.
TO THE APPLICANT'S HIGH SCHOOL COUNSELOR (if applicable): Please attach comments about any unusual factors which you feel warrant special attention, and attach applicant's class rank, college board scores, and official transcript.
