East hartford high school east hartford connecticut



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C O M M O N S C H O L A R S H I P A P P L I C A T I O N

Return completed application and requested documents (if applicable) by mail or drop off to:



East Hartford High School, Guidance Office, 869 Forbes St, East Hartford, CT 06118



EAST HARTFORD HIGH SCHOOL EAST HARTFORD CONNECTICUT
Scholarship applying for: ____ Deadline: ___

Student’s Name: Date of Birth:

Address: Phone:

Father’s Name & Address:

Mother’s Name & Address:

Colleges where you’ve been accepted:



College of your choice:

College Major: 2 yr. 4 yr.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

SCHOOL, EXTRA CURRICULAR ACTIVITIES and

COMMUNITY SERVICE INVOLVEMENT

Organization Your role / Involvement Dates













For guidance use only:



FINANCIAL INFORMATION

List below the name and birth date of each one of your brothers and/or sisters and indicate if and where they are enrolled in school from kindergarten through college and graduate school. If older brothers and/or sisters are enrolled in college and other advanced study, please indicate if they are self-supporting or dependent upon your parents for aid or support.
Name of sibling Birth date School attending Degree of parental

and grade financial support










Does your family have any unusual financial burdens or responsibilities at present (i.e. extensive illness)? If so, please explain.






Father’s occupation and title:

Employed by: years with firm:
Mother’s occupation and title:

Employed by: years with firm:
Please check the range of family gross income

( ) $ 5,000 - $ 9,999 ( ) $25,000 - $29,000 ( ) $50,000 - $59,999

( ) $10,000 - $14,999 ( ) $30,000 - $34,999 ( ) $60,000 - $69,999

( ) $15,000 - $19,999 ( ) $35,000 - $39,999 ( ) $70,000 - $79,999

( ) $20,000 - $24,999 ( ) $40,000 - $49,000 ( ) $80,000 – over

Student’s expected college expenses:

Name of College

Yearly tuition

Lab/other fees

Room & Board

Transportation

Books/Supplies

Clothes

Recreation

Other



Total anticipated

resources for college

Student’s resources for college:

Amount student has saved for college Assistance from parents or guardian

Loans

(Other than those in the

Financial Aid Package)

Financial Aid Package

Grants or Scholarships

Supplemental Grants

Work Study

Loans

Other Scholarships

Total anticipated

resources for college


ADDITIONAL SCHOLARSHIPS

List any scholarships you have already received:

Name of Scholarship Amount









Are there any special circumstances regarding guardianship that should be considered?













_________________________________________________________________________________________
We affirm that the answers to the foregoing questions are true and correct.

Signature of

Parent/Guardian ______________________________________ Date signed
Signature of

Student ___________________________________________ Date signed

Pg

Common scholarship application form-yr 2013


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