Application Test - Hinton Area Foundation

PERSONAL INFORMATION

Name*

First Middle Last

Date of Birth*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone*

Mobile

Email*

Gender

SCHOOL INFORMATION

Name of school in which I plan to enroll*

Major*

School Address*

Street Address City State / Province / Region ZIP / Postal Code

School Website

High School Attended (if multiple list all)

Entering as*

Specify*

PREVIOUS COLLEGE EXPERIENCE

PREVIOUS COLLEGE ATTENDED (IF ANY)	ADDRESS OR WEBSITE	DATES ATTENDED	GPA

EXTRACURRICULAR/COMMUNITY ACTIVITIES

List school, church, and community activities in which you have participated. Also, list any independent projects that you have undertaken and recognition received for academic and extra-curricular activities. Include your work history if you have been or are employed.

SCHOLARSHIP SELECTION

Select the scholarships for which you would like to apply. Each scholarship fund has specific eligibility criteria that were defined by the donor when the fund was established. Please read through the specific criteria to see if you are eligible for any of the funds. Scholarship descriptions are available on the HAF website at HintonAreaFoundation.org, Scholarships page

PARENT INFORMATION

Required if applicant is under 24 years of age.

Father's Name

First Middle Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Mobile Phone

Email

Mother's Name

First Middle Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Mobile Phone

Email

RECOMMENDATIONS*

NAME	RELATIONSHIP TO YOU	PHONE	EMAIL

PERSONAL STATEMENT

Your Personal Statement should present your educational and career aspirations, indicate how the scholarship will assist in reaching those goals, and describe your anticipated contribution to your profession and community following graduation. Your Personal Statement should not exceed one thousand (1,000) words.*

FINANCIAL NEED STATEMENT

Annual Tuition*

Annual Room*

Annual Board*

Total Expenses (Annual Tuition + Annual Room + Annual Board)

$0.00

Scholarship Aid from College*

Aid from Other Sources (specify below)*

Other Sources of Aid (if any)

Total Scholarship Aid (Scholarship Aid from College + Aid from Other Sources)

$0.00

Total Need (Total Expenses – Total Scholarship Aid)

EXTRAORDINARY CIRCUMSTANCES (OPTIONAL)

If any extraordinary financial circumstances which you believe are not reflected in the information already submitted and which you believe affect you or your family’s ability to pay for your education should be taken into consideration, please explain them below.

TRUTH IN SUBMISSION STATEMENT

I hereby certify that the information set forth in this application is true to the best of my knowledge. Furthermore, I hereby grant permission to the Hinton Area Foundation or its representative to contact any Financial Aid Officer, Guidance Counselor, or other school official at any school in which I am enrolled, have been previously enrolled, or to which I have made application. Contact may be made for the purpose of soliciting and obtaining information that may be necessary or helpful to the Foundation in understanding my academic career and financial needs in connection with the processing of this application. Contact with these individuals may also be made for auditing the use of scholarship funds received because of application made to The Hinton Area Foundation Scholarship Program. HAF may contact these individuals for auditing the use of HAF scholarship funds received by the applicant.

Name*

First Last

Date*

Letters of Recommendation

Drop files here or