MARYJANE CARR SCHOLARSHIP FUND RECIPIENT INFORMATION FORM ‘Administered by FirstMerit PrivateBank 100 E. Michigan Avenue, Suite 200, Jackson, MI 48201 Phone: 817.788.2772 Fax: 517.788.2776 TO BE COMPLETED BY STUDENT RECIPIENT: Name: Bochanan Rucka Dames Last First Middle High Schoot __S esas Po aA ian Sehool Home Address: S95) \S Bee Noda ‘Strgct Binon M3 ay Gy State Zip Home Phone: S\7]- 2S) - 31729 Cell Phone: SA -33\- 4557 Email Address: Mi PLEASE PRAT CLEARLY! Social Seourty Number, 10 ~ LA — WB College You Plan to Attend: ( \aweXe Co\Weoe. ‘Ave you or your family an employes of FirstMerit Bank, NA? D Yes YQNo Do you have a financial need for this scholership (Annual family gcjusted gross income (AGI) as reported on incame taxes of $80,000 or less) yes TI Ne Grade Point Average (must be 2:5 or higher to qualify): “LW1%_ ATTACH TRANSCRIPT We the undersigned understand that any intentional falsification of any of the statements made in this application may eliminate me from any further consideration. ‘Applicants Sfenature Dat Parent/Guardian Signature iF Applicant under 18 Date TO BE COMPLETED BY HIGH SCHOOL: S hereby recommends the above student to receive a scholarship Name of High School in the amount of $1,180 from the Maryjane Carr Scholarship Fund. Date Printed name & title of person signing on behalf of school Phone Number:— 1 StinJ Buchanan 51H DriveN , MI 49224 ee je: 12 SBS of: 2015 BGA Cohort: 2015 n & ere acourse ito Birth Date: 02/28/1997 Student Numbor: 1471 Springport High School 300 W Main Street Springport, MI 49284 Phone - 517-857-3475 Fax - 517-857-3251 Si] 2] 11] 12) Ta] Sa | School Course Info Tes] nr] rao -B Sprngport High Sehoo! Founda At See Stalasioneny Sy Tan tA 21792 onal ance 1A ere ea Eason erenen So or S027 Sets 1. Springport High School 42S ining Sr Peep nee POT Foundstonal at eS onenes ean ik ert erent Srysical Education 43 Springport High School obra mgerre 8 42! 8 050 8 050 cs 050 a 080 a 50 a 0.50 A 080 pele 1.00 e+] c | 4.00 D+] 050 jpe|a 4.00 Be] 050 > 080 c-| 050 8 050 8 050 aol 1.00 F 0.00 e 050 oneptal Pye 8 cle {2° [rest Scores Other Acadomic Info ingiish 1018 on] 00 | ACT English 160 [Total Credits Eamed: 25.00 patsh 10 1B ° 080 | ACT - Reading 170 |ap cpa 2473 us History 14 7 0.50) ACT - Math 17.0 |AP Rank: 35 of 60 us Hoy 1B alt 980 | AGT. Stience 190 pinysice! Esueaton /ACT - Writing 0.9 | sim | reading Exploration B+] Ae 400 Jacr-engiswwning 0.0 fame ore ae Ree cla 100 act Composite azo [empe Rate ‘4-12 Springpor High Shoot H4inQalP Mit Exal@l"4#2013 2 aigebre mle 190 | Reading 0.0 aril clo soo |Reagin Aa pioleay A oo auso_| tin oe Bea lg £2 Science 00 omy 7 $3 | Social Studies 0.0 eometyiA Fl 000 Geomety 8 F| 00 {Gobel Skies 1A o 050 (Gibal Stl 1B ° 00 | eat Lg c 050 | Peat Ling PE a 050 | Fpenetions | ca| 00 | zeae 050 | zoology | 080 \ \ aaa TTT | ‘ct en sro ine pe 6884017672 District: 38150 ‘School: 03674 OFFICIAL TRANSCRIPT