4510 Collins Boulevard, Suite 6 Ashtabula, Ohio 44004



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4510 Collins Boulevard, Suite 6

Ashtabula, Ohio 44004

Phone: (440) 992-6818

Fax: (440) 992-0724

ashtabulafdn@suite 224.net



www.ashtabulafoundation.org

EDWARD J. HARVEY SCHOLARSHIP FUND




PURPOSE


“To help deserving young people to acquire an education that will enable them to become self- supporting, useful citizens.”

ELIGIBILITY


Any person with a legal residence in Ashtabula County as determined by post office address and who will be graduating from a high school in Ashtabula County is eligible to apply for this scholarship. An applicant must be planning to attend any higher education institution on a full-time basis. An institution must be accredited by a regional accrediting association.

STANDARDS


Preferences will be given to students showing financial need and satisfactory academic achievement or ability (GPA of 2.5 or above). The following rubric has been selected as a guideline in the selection process:
GPA 25 points

ACT/SAT Scores 15 points

Income/Financial Need 25 points

Essay 10 points

Outside Activities 25 points

Total 100 points


Scholarship recipients will become ineligible for future grants if placed on probation for more than one term consecutively.

GRANTS


Scholarships will be awarded for tuition and fee costs, granted proportionately to the institution’s terms. The number of awards each year is contingent upon the number of continuing student awards. Numbers of scholarships may vary if funds available increase or decrease.

Scholarships are renewable up to four years for undergraduate degrees. Formal request for renewal is required each year. The submission of a current transcript and the college tuition statement constitutes a formal request. It is the responsibility of the recipient to submit a transcript and college tuition statement to The Ashtabula Foundation to be considered for renewal. Checks will be sent to the recipient, payable to the recipient and institution. * Please note there is a two-week processing period for the issuance of checks. In the event the student withdraws or becomes ineligible during the term, the refund is to be made payable to The Ashtabula Foundation.



APPLICATION


Forms are available at all Ashtabula County High School Guidance offices, as well as The Ashtabula Foundation, 4510 Collins Boulevard, Suite 6, Ashtabula, Ohio 44004, Phone (440) 992-6818. Applications are also available for download at ashtabulafoundation.org. Individuals must submit a completed application along with a copy of your signed high school transcript, a copy of the FAFSA (Free Application for Federal Student Aid) form, and/or a copy of your SAR (Student Aid Report), and 500 word essay directly to the Edward J. Harvey Scholarship Fund Committee, c/o The Ashtabula Foundation, 4510 Collins Boulevard, Suite 6, Ashtabula, Ohio 44004, postmarked by the last business day in March. Awards will be made no later than the end of April.

THIS SECTION TO BE COMPLETED BY APPLICANT



PRINT OR TYPE


Date ___________________
Name ________________________________________________________________________

Last First Middle
Home Address _________________________________________________________________

Street City State Zip
Telephone Number _____________________ E-mail: _____________________________

High School Attending __________________________________



THIS SECTION TO BE COMPLETED BY

HIGH SCHOOL GUIDANCE COUNSELOR

Grade Point Average _______________________ Rank in Class ______________________


ACT Score __________________________ and/or Composite SAT Scores _______________
Guidance Counselor Signature ____________________________________________________

I hereby declare that, to the best of my knowledge and belief, the information in this application is correct.


Date _____________ Applicant _____________________________________________



(Signature)
Date _____________ Parent or Guardian ______________________________________

(Signature)


THIS SECTION TO BE COMPLETED BY APPLICANT

School in which you plan to enroll or are enrolled:


Name
City State Zip
Date of entry into school (approximate) _____________________________________________________________
Course of study to be followed ____________________________________________________________________
Have you applied for or received any other grants or scholarships? (O.I.G.; Pell Grant, for example) ____ Yes ____ No
If yes, from whom and amount ____________________________________________________________________
Are you entitled to any government educational benefits? ____ Yes ____ No
If yes, from whom and amount ____________________________________________________________________
ESTIMATED BUDGET FOR 20_______ - 20_______ ACADEMIC YEAR

ESTIMATED EXPENSES:

University Fees $____________ Savings to be used $____________________

Room and Board $____________ Prospective Earnings $____________________

Books and Supplies $____________ Aid from Parents $____________________

Traveling Expenses $____________ Aid from Other Sources $____________________

Total A $____________ Total B $____________________

TOTAL A MINUS TOTAL B = AMOUNT NEEDED $___________________


FAMILY INCOME STATEMENT

TO BE COMPLETED BY PARENT OR GUARDIAN


This information is used to select grantees on an equitable basis. All information will be held in strict confidence. NO unauthorized persons will have access to this document.
Salary, wages, and income from business, if self-employed, before taxes $___________________________ but minus business expenses listed on federal income tax return

(use 1040 EZ, Line 4 or 1040, Line 31, or 1040A, Line 16 from tax return)


Income earned by father, stepfather, legal guardian (circle one) $___________________________
Employer ____________________________________________________
Income earned by mother, stepmother, legal guardian (circle one) $___________________________
Employer ____________________________________________________

UNEARNED INCOME:


Income from retirement, income from government agencies such as

Veteran’s benefits, social security benefits, welfare benefits, etc. $___________________________


Parents’ Savings $________________________________
Student’s Savings $________________________________
Number of children claimed on tax exemptions. If you do not file a

Federal income tax statement, number of dependent children of the parents. ____________________________


Please describe any extenuating financial circumstances (for example: job loss; grandparents supported by family, large debts, illness, medical expenses, etc.)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Please provide information regarding extracurricular activities, including school-related activities, work history, volunteer activities: *


Activity Number of hours per week
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
* A maximum of two (2) additional pages may be attached if necessary.

As an attachment to this application, provide a typed essay of 500 words or less describing your career goals, life mission and why you feel you should be a recipient of this scholarship.




Individuals must submit a completed application and attachments directly to the Edward J. Harvey Scholarship Fund Committee, c/o The Ashtabula Foundation, 4510 Collins Boulevard, Suite 6, Ashtabula, Ohio 44004, by the last business day in March. Awards will be made no later than the end of April.

Rev 2015
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