Knights of Columbus Council #12376

100 Crestwood Blvd. S.

Royal Palm Beach, FL 33411

 

SCHOLARSHIP APPLICATION

 

Date: _______________

                                                               

    1.)  APPLICANT INFORMATION:

 

Name____________________________________________________________   Sex ___________

 

 

Address: _________________________________________________________________________

  No. & Street

 

               ___________________________________________________________|_________|____________

                               City                                                            State              Zip

 

Telephone __________________________  Date of Birth  _________________________________

 

                                                             Place of Birth _________________________________

_________________________________________________________________________________

 

 

 2.)  FAMILY INFORMATION:

 

         Father's Name  _______________________________  Occupation_____________________

 

         Place of employment _________________________    Annual Income__________________

                                                                                                               (verified)                        

         Mother's Maiden Name ________________________   Occupation _____________________

 

         Place of Employment __________________________  Annual Income __________________

                                                                                                                (verified)                  

 

 

Student lives with (check one)

 

                               ___ Mother & Father                         ___ Mother

                               ___ Father                                      ___ Guardian - Explain

             

 

Parents Marital Status:          ___ Married      ___ Divorced      __ Separated

 

List names and ages of brothers and sisters and indicate the school they are currently attending

 

Name ______________________________  Age ___  School  _________________________

 

Name ______________________________  Age ___  School  _________________________

 

Name ______________________________  Age ___  School  _________________________

 

3. 3.)  SCHOOL INFORMATION:

 

          Name of school currently attending: ____________________________________________

 

          Date of expected Graduation:  _________________________________________________

 

  GPA for last 4 years:          _______           ______           _______           _______

 

            PSAT Scores:          Verbal:  _______________      Math:  ___________

 

          SAT Scores:            Verbal:  ___________      Math:  ___________

            ACT Composite scores

 

What is your present class schedule:

 

                        ______________________________     _____________________________

 

                        ______________________________     _____________________________

 

                        ______________________________     _____________________________

 

                        ______________________________     _____________________________

           

           Essay (subject to be determined)  Attach a copy of current transcript.

 

4.) 4.)  CHURCH and COMMUNITY INVOLVEMENT:

 

List all clubs, organizations & activities you are involved in:

 

    _______________________________________________________________________________________________

 

    _______________________________________________________________________________________________

 

 

What are your interests, hobbies & pastimes?

 

    _______________________________________________________________________________________________

 

    _______________________________________________________________________________________________

 

 

List any work experience & indicate if you are currently employed:

 

   ____________________________________________________________________________

 

Hours worked per week __________________________

 

Do you own a car?  _______  Are you fully responsible for all expenses of this car?  ________

 

    List the Catholic schools that you have applied and indicate whether you have been accepted.

 

   ____________________________________________________________________________    

 

 5:)  FINANCIAL NEED:

 

    List any financial aid and/or scholarships you have already received or for which you are applying.

        ____________________________________________________________________________

 

        ____________________________________________________________________________

 

    Describe any special circumstances regarding your financial need:  _______________________

____________________________________________________________________________

 

 

 

By my signature below I certify that I am a practicing Catholic and a relative of a member in good standing of the K of C Council 12376.  I intend to enroll as a full time student in a Catholic grammar school, high school or college for the coming school year. I understand that any unused portion of the awarded scholarship will be returned to the K of C Council 12376 if I cease attending classes and/or withdraw from school without immediately enrolling in another Catholic school.

 

 

Applicant's Signature:   _________________________________________   Date: __________

 

Parent's Signature:       _________________________________________   Date: __________

 

Pastor's Signature:       _________________________________________   Date: __________