THE McCURRY FOUNDATION, INC.

SCHOLARSHIP PROGRAM
The Scholarship Selection Committee of The McCurry Foundation, Inc. accepts applications from all interested seniors attending public high school. The deadline to apply is February 15th. Scholarships are awarded no later than une 15th and will be paid directly to the educational institution prior to the Fall semester tuition deadline. !lthough geographical preference will be gi"en to applicants from the Florida counties of Clay, #u"al, $assau and St. ohns and from %lynn County, %eorgia, all public high school students ha"ing a minimum %&! of '.( and employment e)perience will be considered. Scholarships will be awarded for the upcoming college year and consideration will be gi"en to ma*ing awards in subse+uent years depending on the recipient,s college performance. The enclosed +uestionnaire is silent on gender, race, religion, physical handicap, foreign origin, and se)ual preferences, which are not factors in the selection process. The purpose of this +uestionnaire is to analy-e the applicant,s performance. Financial need is one of the many factors considered. The combined annual earnings of the student and parents must not e)ceed ./5,((( 0as measured by 1!d2usted %ross Income3 on your income ta) returns4. 5ther factors considered are academic success, leadership, wor* e)perience, scholarship e)cellence and awards, and community in"ol"ement and ser"ice. Illegal aliens and others in "iolation of applicable Florida and federal laws are not eligible for consideration. !pplicants may be re+uired to inter"iew with the Scholarship Selection Committee as part of the final selection process. GENERAL INSTRUCTIONS: 1. *. Please prin in !l"e #r !lac$ in$ #r %pe. A le&i!le p'# #c#p% #( 'is (#r) is accep a!le. C#)ple e 'is applica i#n in i s en ire % an+ re "rn i #, Sc'#lars'ip Selec i#n C#))i ee T'e McC"rr% F#"n+a i#n, Inc. --1. /eac' /#"le0ar+, S"i e *11 2ac$s#n0ille, Fl#ri+a 3**1.4-.53 C#)ple e+ applica i#ns 6i ' essa% an+ a7 re "rn8s9 )"s !e p#s )ar$e+ !% Fe!r"ar% 1: '. Le ers #( rec#))en+a i#n an+ ranscrip s )a% !e )aile+ separa el%, !" all in(#r)a i#n )"s !e p#s )ar$e+ !% Fe!r"ar% 1: '. All in(#r)a i#n pr#0i+e+ in 'is applica i#n 6ill !e rea e+ as c#n(i+en ial.

3.

-.

6e"ised 1(1'

THE McCURRY FOUNDATION, INC. --1. /eac' /#"le0ar+, S"i e *11 2ac$s#n0ille, Fl#ri+a 3**1.4-.53 in(#;)cc"rr%(#"n+a i#n.#r& SCHOLARSHIP APPLICATION $ame7888888888888888888888888888888888 #ate of 9irth7 888888888888888888888888 Student,s :;Mail !ddress7 88888888888888888888888888888888888888888888888888888 &ermanent Mailing !ddress7 888888888888888888888888888888888888888888888888888 City7 8888888888888888888888 County7 88888888888888 State78888888888 <ip7 888888 &arents, $ames7 8888888888888888888888888888888888888888888888888888888888888 Telephone $umber7 =ome7 888888888888888888 &arent >or*7 8888888888888888888888 =igh School you currently attend7 88888888888888888888888888888888888888888888888 Citi-enship7 0 4 ?.S. 0 4 5ther 888888888 #o you plan to marry within the ne)t year@ 88888 $ames and locations of colleges to which you ha"e been accepted and are considering7 888888888888888888888888888888888888888888888888888888888888888888888888888 888888888888888888888888888888888888888888888888888888888888888888888888888 888888888888888888888888888888888888888888888888888888888888888888888888888 !nticipated College ma2or 0s47 88888888888888888888888888888888888888888888888888 FINANCIAL INFORMATION The purpose of this in+uiry about the student,s finances is to compare the student,s resources with the student,s pro2ected needs. School loans obtained by the prospecti"e recipient are not considered 1income3, but scholarships and grants are considered 1income3. &65 :CT:# :#?C!TI5$!A 9?#%:T !$$?!A :B&:$S:S7 Tuition and fees .888888888888 =ousing 888888888888 Food C Misc. 888888888888 ?tilities 888888888888 9oo*s C Supplies 888888888888 Tra"el bac* home 888888888888 5ther7 888888888 888888888888 TOTAL E<PENSES =>>>>>>>>>>>>> !$$?!A 6:S5?6C:S7 Father,s $et Income .888888888888 Mother,s $et Income 888888888888 Student,s $et Income 888888888888 Social Security 9enefits 888888888888 Deteran,s 9enefits 888888888888 5ther7888888888 888888888888 TOTAL RESOURCES =>>>>>>>>>>>

6e"ised 1(1'

Aist Scholarships and %rants for which you ha"e applied and indicate if awarded7
Chec* appropriate bo)0es4 $ame of Scholarship !mount !pplied for !warded

Aist siblings and ages7888888888888888888888888888888888888888888888888888888888 888888888888888888888888888888888888888888888888888888888888888888888888888 State any special personal or family circumstances affecting your need for financial assistance 0for e)ample7 parent0s4 not currently gainfully employed or able to wor*, parent0s4 need to support their elderly parents, etc.4. 888888888888888888888888888888888888888888888888888888888888888888888888888 888888888888888888888888888888888888888888888888888888888888888888888888888 88888888888888888888888888888888888888888888888888888 0attach letter if necessary4 !C!#:MICS, !CTIDITI:S, !$# :M&A5FM:$T !ppro)imate %&! on a G.( scale 88888888 !ppro)imate 1weighted3 %&! 88888888888 S!T Score7 !CT Score7 6eading 8888888 Math 8888888 >riting 88888888 Total 8888888888888 Composite 888888888888

6an* in class 05btain from your high school counselor47 888888 out of 888888 in the 1E th grade on or about the end of the first semester.

:mployer

Type of >or*

Chec* appropriate bo)0es4 Summer School Fear

#ates of :mployment

=oursHw*

May we contact your current and former employer@ 88888888888 #o you plan to wor* during college@ 888888888
6e"ised 1(1'

'

PLEASE ATTACH TO THIS APPLICATION THE FOLLO?ING, 1. Res")e to include =onor, !d"anced &lacement, I9 and #: classes ta*en, honors and awards recei"ed, and school and community acti"ities in which you ha"e participated, indicating leadership positions held, with e)planation of organi-ation,s purpose, goals, and acti"ities. 5ne page double;spaced essa% of appro)imately E5( words describing an e"ent or acti"ity in which you too* a leadership role. :)plain why it was meaningful or significant to you. &hotocopy of rep#r car+ from most recent grading period. Copy of applican @s most recently filed federal income a7 re "rn. Copy of your c"rren FAFSA Applica i#n In(#r)a i#n or your c"s #+ial paren 8s9@ most recent federal income ta) return.

E.

'. G. 5.

PLEASE ATTACH TO THIS APPLICATION OR MAIL SEPARATELY THE FOLLO?ING, 1. E. '. =igh school ranscrip . ! le er #( rec#))en+a i#n from a teacher or school administrator. ! le er #( rec#))en+a i#n from a past or present employer, clergy member, civic or business leader, or other person who knows you well 0n# (r#) a eac'er #r sc'##l a+)inis ra #r4.

On )% '#n#r, I cer i(% 'a 'is applica i#n 'as !een c#)ple e+ as acc"ra el% as p#ssi!le an+ 'a I 6ill n# i(% 'e Sc'#lars'ip Selec i#n C#))i ee #( T'e McC"rr% F#"n+a i#n, Inc. i( 'ere are an% si&ni(ican c'an&es in )% (inancial res#"rces, incl"+in& # 'er #" si+e sc'#lars'ip a6ar+s. /% si&nin& 'e applica i#n !el#6, I "n+ers an+ 'a 'e )e)!ers #( 'e Sc'#lars'ip Selec i#n C#))i ee 6ill )#ni #r an+ (#ll#6 "p #n 'e pr#per "se #( sc'#lars'ip ("n+s, an+ I c#nsen # 'e 0eri(ica i#n #( )% c#lle&e enr#ll)en , rela e+ e7penses, an+ aca+e)ic ranscrip s an+ # 'e release #( )% na)e, 'i&' sc'##l, li$eness an+ # 'er &eneral, n# (inancial, in(#r)a i#n in 'e e0en #( a6ar+.

!pplicant,s signature 88888888888888888888888888888888888888888 #ate 888888888888 !pplicant,s parent signature 888888888888888888888888888888888888#ate 888888888888 !pplicant,s parent signature 888888888888888888888888888888888888#ate 888888888888

6e"ised 1(1'