YALE LOCAL SCHOLARSHIPS

Name of Applicant:
Address:
E-mail:
Choice of College:

Date of Birth:
Expected Date of Entry:

Curriculum Choice:
Fathers Name:
Mothers Name:
Do you reside with both parents?

Occupation:
Occupation:
Yes

No

Names of children in your family OLDER than yourself and living at home:
Name:
Name:
Name:

Age:
Age:
Age:

Name:
Name:
Name:

Age:
Age:
Age:

Names of children in your family YOUNGER than yourself and living at home:
Name:
Name:
Name:

Age:
Age:
Age:

Name:
Name:
Name:

Age:

Age:

Age:

How many in your family, excluding yourself, will be attending college next year?
Where?
School Activities:List any school activities in which you have been involved and any offices you have
held. A brag sheet may be attached.
9th Grade

11th Grade

10th Grade

12th Grade

Community Service: List community activities in which you have been involved.
9th Grade

10th Grade

11th Grade

12th Grade

Please state how you will finance your first year of college. Include any form of financial aid that you
will receive including such things as money saved, scholarships received, etc:
Scholarship:

Amount:

Scholarship:

Amount:

Scholarship:

Amount:

Did you file a FAFSA (Free Application for Federal Student Aid):

Yes

No

ON A SEPARATE SHEET OF PAPER, PLEASE TYPE A SUMMARY OUTLINING THE FOLLOWING:

A. Why you feel you deserve this scholarship.
B. What are your career plans after college?
C. What contribution have you made to our school and your family?
**Transcript will be attached
YOU MUST INCLUDE ONE LETTER OF RECOMMENTATION
D. One letter of recommendation from a person in the high school who knows you well.(This letter of recommendation
may cover the applicants ability, work habits, leadership, personality and integrity.)

Applicants signature ________________________________________________Date:_____________

RETURN THIS COMPLETED FORM TO YOUR COUNSELOR NO LATER THAN FEBRUARY 14, 2013
-----------------------------------------------------------------------------------------------------------------------------------------------------------------PLEASE DO NOT FILL THIS IN

Overall G.P.A.

__________

Rank:

_________
_

out of

__________