4510 Collins Boulevard, Suite 6 Ashtabula, Ohio 44004
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- EDWARD J. HARVEY SCHOLARSHIP FUND
- THIS SECTION TO BE COMPLETED BY APPLICANT
- THIS SECTION TO BE COMPLETED BY
- TOTAL A MINUS TOTAL B = AMOUNT NEEDED $___________________
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 FUNDPURPOSE“To help deserving young people to acquire an education that will enable them to become self- supporting, useful citizens.” ELIGIBILITYAny 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. STANDARDSPreferences 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. GRANTSScholarships 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. APPLICATIONForms 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 BYAPPLICANTPRINT OR TYPEDate ___________________ Name ________________________________________________________________________ Last First Middle Home Address _________________________________________________________________ Street City State Zip Telephone Number _____________________ E-mail: _____________________________ High School Attending __________________________________ THIS SECTION TO BE COMPLETED BYHIGH SCHOOL GUIDANCE COUNSELORGrade 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 APPLICANTSchool 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 $____________________
FAMILY INCOME STATEMENTTO BE COMPLETED BY PARENT OR GUARDIANThis 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 Download 57.77 Kb. Share with your friends:
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