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 June 15th and will be paid directly to the educational institution prior to the Fall semester tuition deadline. Although geographical preference will be given to applicants from the Florida counties of Clay, Duval, Nassau and St. Johns and from Glynn County, Georgia, all public high school students having a minimum GPA of 3.0 and employment experience will be considered. Scholarships will be awarded for the upcoming college year and consideration will be given to making awards in subsequent years depending on the recipients college performance. The enclosed questionnaire is silent on gender, race, religion, physical handicap, foreign origin, and sexual preferences, which are not factors in the selection process. The purpose of this questionnaire is to analyze the applicants performance. Financial need is one of the many factors considered. The combined annual earnings of the student and parents must not exceed $75,000 (as measured by Adjusted Gross Income on your income tax returns). Other factors considered are academic success, leadership, work experience, scholarship excellence and awards, and community involvement and service. Illegal aliens and others in violation of applicable Florida and federal laws are not eligible for consideration. Applicants may be required to interview with the Scholarship Selection Committee as part of the final selection process. GENERAL INSTRUCTIONS: 1. Please print in blue or black ink or type. A legible photocopy of this form is acceptable. 2. Complete this application in its entirety and return it to: Scholarship Selection Committee The McCurry Foundation, Inc. 4417 Beach Boulevard, Suite 200 Jacksonville, Florida 32207-4783 3. Completed applications with essay and tax return(s) must be postmarked by February 15th. Letters of recommendation and transcripts may be mailed separately, but all information must be postmarked by February 15th. 4. All information provided in this application will be treated as confidential.

Revised 1012

THE McCURRY FOUNDATION, INC. 4417 Beach Boulevard, Suite 200 Jacksonville, Florida 32207-4783 SCHOLARSHIP APPLICATION Name:_________________________________ Date of Birth: ________________________ Students E-Mail Address: _____________________________________________________ Permanent Mailing Address: ___________________________________________________ City: ______________________ County: ______________ State:__________ Zip: ______ Parents Names: _____________________________________________________________ Telephone Number: Home: __________________ Parent Work: ______________________ High School you currently attend: _______________________________________________ Citizenship: ( ) U.S. ( ) Other _________ Do you plan to marry within the next year? _____ Names and locations of colleges to which you have been accepted and are considering: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Anticipated College major (s): __________________________________________________ FINANCIAL INFORMATION The purpose of this inquiry about the students finances is to compare the students resources with the students projected needs. School loans obtained by the prospective recipient are not considered income, but scholarships and grants are considered income. PROJECTED EDUCATIONAL BUDGET ANNUAL EXPENSES: Tuition and fees $____________ Housing ____________ Food & Misc. ____________ Utilities ____________ Books & Supplies ____________ Travel back home ____________ Other: _________ ____________ TOTAL EXPENSES $_____________ ANNUAL RESOURCES: Fathers Net Income $____________ Mothers Net Income ____________ Students Net Income ____________ Social Security Benefits ____________ Veterans Benefits ____________ Other:_________ ____________ TOTAL RESOURCES $___________

Revised 1012

List Scholarships and Grants for which you have applied and indicate if awarded:
Name of Scholarship Amount Check appropriate box(es) Applied for Awarded

List siblings and ages:_________________________________________________________ ___________________________________________________________________________ State any special personal or family circumstances affecting your need for financial assistance (for example: parent(s) not currently gainfully employed or able to work, parent(s) need to support their elderly parents, etc.). ___________________________________________________________________________ ___________________________________________________________________________ _____________________________________________________ (attach letter if necessary) ACADEMICS, ACTIVITIES, AND EMPLOYMENT Approximate GPA on a 4.0 scale ________ Approximate weighted GPA ___________ SAT Score: ACT Score: Reading _______ Math _______ Writing ________ Total _____________ Composite ____________

Rank in class (Obtain from your high school counselor): ______ out of ______ in the 12th grade on or about the end of the first semester.

Employer

Type of Work

Check appropriate Summer box(es)School Year

Dates of Employment

Hours/wk

May we contact your current and former employer? ___________ Do you plan to work during college? _________

Revised 1012

PLEASE ATTACH TO THIS APPLICATION THE FOLLOWING: 1. Resume to include Honor, Advanced Placement, IB and DE classes taken, honors and awards received, and school and community activities in which you have participated, indicating leadership positions held, with explanation of organizations purpose, goals, and activities. 2. One page double-spaced essay of approximately 250 words describing an event or activity in which you took a leadership role. Explain why it was meaningful or significant to you. 3. Photocopy of report card from most recent grading period. 4. Copy of applicants most recently filed federal income tax return. 5. Copy of your 2012-2013 FAFSA Application Information or your custodial parent (s) most recent federal income tax return. PLEASE ATTACH TO THIS APPLICATION OR MAIL SEPARATELY THE FOLLOWING: 1. High school transcript. 2. A letter of recommendation from a teacher or school administrator. 3. A letter of recommendation from a past or present employer, clergy member, civic or business leader, or other person who knows you well (not from a teacher or school administrator).
On my honor, I certify that this application has been completed as accurately as possible and that I will notify the Scholarship Selection Committee of The McCurry Foundation, Inc. if there are any significant changes in my financial resources, including other outside scholarship awards. By signing the application below, I understand that the members of the Scholarship Selection Committee will monitor and follow up on the proper use of scholarship funds, and I consent to the verification of my college enrollment, related expenses, and academic transcripts and to the release of my name, high school, likeness and other general, not financial, information in the event of award.

Applicants signature _________________________________________ Date ____________ Applicants parent signature ____________________________________Date ____________ Applicants parent signature ____________________________________Date ____________

Revised 1012