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 Cyndi's
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Application, page 2
7. Other family members in same household:
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.
Applicant's signature ______________________________
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.
Counselor's Signature _____________________________
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2011 Scholarship Financials
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