Paxtonia Scholarship Application Form - Paxtonia Elementary PTA

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Paxtonia Elementary PTA
College Scholarship Application
Please note: This application must be personally completed by the applicant.
A. APPLICANT
Name: _________________________________________________________________
(Last) (First) (Middle)
Address: _________________________________________________________________
(Street)
_________________________________________________________________
(City) (State) (Zip)
Phone Number: (_____)_____________________
Age: ____________
B. FAMILY
Father’s Full Name: __________________________
Address (if different from yours):
_________________________________________________________________________
(Street) (City) (State) (Zip)
Mother’s Full Name: __________________________
Address (if different from yours):
_________________________________________________________________________
(Street) (City) (State) (Zip)
If someone other than your father or mother supports you, give the following information
about him/her:
Name: _________________________________ Relationship to you: ________________
_________________________________________________________________________
(Street) (City) (State) (Zip)
Sibling’s Name Age School Attending
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

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C. ESTIMATED EXPENDITURES
List your estimated budget for your freshman year. Consult your college’s catalog for aid in
estimating expenses.
Name of Institution: ________________________________________________________
Address: _________________________________________________________________
Estimated Annual College Expenses:
Tuition:
Room and Board:
Books and Materials:
Fees/Other
Total Estimated Annual Cost
$ _____________
_____________
_____________
_____________
$ _____________
Less: Expected Scholarships/Aid ( ______________ )
Total Estimated Annual College Expenses
$ ______________
D. STATEMENT OF FINANCIAL NEED
List the percentage below that shows how your Total Estimated Annual College Expenses
will be paid for.
% to be paid for by parents/relative _________%
% to be paid for by the student _________%
% to be paid for with student loans _________%
% to be received from other source _________% Please list source:_________
Total 100 %

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E. EDUCATION
Elementary School and Grades Completed From Year To Year
_____________________________________ ____________ ____________
_____________________________________ ____________ ____________
Graduating High School: ___________________________ Date of Graduation: ________
Briefly, state what course of study you plan to follow after graduation and your vocational
plans.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
F. WORK EXPERIENCE
List jobs, including summer employment, you have held in the past two years.
________________________________________________________________________
(Employer)
________________________________________________________________________
(Job Title/Description)
________________________________________________________________________
(Date Employed)
(# of Hrs Worked Per Week)
________________________________________________________________________
(Employer)
________________________________________________________________________
(Job Title/Description)
________________________________________________________________________
(Date Employed)
(# of Hrs Worked Per Week)
________________________________________________________________________
(Employer)
________________________________________________________________________
(Job Title/Description)
________________________________________________________________________
(Date Employed)
(# of Hrs Worked Per Week)

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G. LIST ANY AWARDS OR RECOGNITION YOU HAVE RECEIVED
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
H. ACTIVITIES
List your co-curricular and community activities while a student in high school. Indicate any
position of leadership you may have held in these activities. (Examples: student
government, drama, athletics, debating, publications, place of worship, service or interest
groups)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
I. Submit two letters of personal recommendation. One letter of recommendation must
be from the applicant’s past or present teacher. The second letter of recommendation
must be from a non-family member. (Examples: teacher, minister, employer, etc.)
J. Submit a written essay 1) telling us about yourself, 2) explaining why you believe you
should receive this scholarship and 3) any other information that you would like us to
know. Please limit to one page.
K. Submit a copy of your Letter of Acceptance from your post-secondary institution.
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Contact the guidance office at your high school by March 15 th and arrange to have
your official transcripts sent directly to the address below. Transcripts and applications
must arrive by March 25th in order to be considered for this scholarship.
Paxtonia Elementary PTA
Attention: Karen Parody/ PTA SCHOLARSHIP COMMITTEE
6135 Jonestown Road
Harrisburg, PA 17112