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JENNY MELTON SCHOLARSHIP

2013 APPLICATION
The Jenny Melton Scholarship fund was established in 2002 in Jennys memory by her family and friends. Jenny, a West
Hall High School athlete and honor student, tragically lost her life on March 19, 2002 in a single car accident on her way to
school.
Three $2,500 non-renewable scholarships are available each year to graduating high school seniors. One award is
available to graduating seniors at West Hall High School. One award is available to graduating seniors at Flower Branch
High School, and one award is available for children of members of IAEE Atlanta SE Chapter who are graduating high
school seniors.
Applicants must be planning to pursue a full-time degree program at an accredited U.S. institution of higher learning in fall
2013. Financial need is the primary consideration for this scholarship. School and community involvement and faculty
recommendations and references are also considered.
Please fill out the information below completely and print clearly. If space provided in any section is inadequate, you may
continue on additional sheets of paper using the same format. Be sure to include your name, address, and the name of
the scholarship on all attachments
I.

PERSONAL INFORMATION

Applicants Full Name: ______________________________________________________________________________


Mailing Address: ___________________________________________________________________________________
_________________________________________________________________________________________________
E-mail Address: ___________________________________________________________________________________
Home Phone Number: ____________________________

Cell Phone Number: ____________________________

High School: ______________________________________________________________________________________

II.

PARENT/GUARDIAN INFORMATION

Parent/Guardian (full name): _________________________________________________________________________


Day Phone: _____________________________

Relationship to Applicant: ______________________________

Place of employment and title: ________________________________________________________________________


Parent/Guardian (full name): _________________________________________________________________________
Day Phone: _____________________________

Relationship to Applicant: ______________________________

Place of employment and title: ________________________________________________________________________

This application form consists of 3 pages. If you are missing any pages, please go to www.ngcf.org for the complete form.

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Jenny Melton Scholarship 2012-2013 Academic Year

III.
POST SECONDARY SCHOOL DATA
List the colleges or universities to which you have applied and/or to which you have been accepted. List these in order of
your choice.
st

1 Choice: ________________________________________________________________________________________
Accepted?
Yes
No
Pending
nd

2 Choice: _______________________________________________________________________________________
Accepted?

Yes

No

Pending

rd

3 Choice: _______________________________________________________________________________________
Accepted?

Yes

No

Pending

Intended Major: _____________________________________

IV.
FINANCIAL INFORMATION
Please complete the following questions entirely. Verification of financial information may be required.
Current net total annual household income of your parent(s) _______________
Number of children in your family (including yourself) _______________
Number of children in college (including yourself) _______________
Number of children, under the age of 20, living at home (do not include yourself) _______________
Amount of your (students) personal income _______________
Amount of savings you anticipate using for college expenses _______________
Total value of all scholarships received for the coming year (including HOPE) _______________
Amount of federal or state funded student loans (if eligible) _______________
List the names and amounts of other scholarships for which you have applied but are still pending:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Any unusual family situations affecting financial status _____________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

This application form consists of 5 pages. If you are missing any pages, please go to www.ngcf.org for the complete form.

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Jenny Melton Scholarship 2012-2013 Academic Year

V.
ACTIVITIES, AWARDS & HONORS
List all school activities in which you have participated during the past four years. Note all leadership positions held,
special awards and honors.
Activity

Years
Participated

Special Awards, Honors

Offices Held

VI.
ESSAY
Please attach your typed responses to the following selection criteria requirements. Number each response in the order
they are listed.
1. Describe how this scholarship can help further your chosen career.
2. Describe your philosophy regarding community service, cite a project that you worked on and how you benefited
from it or describe a project that you hope to do in the future.
To be considered eligible, West Hall and Flowery Branch High School students should return the following
documents in one packet to your guidance counselor. IAEE Atlanta-Southeast Chapter member children should
return their complete packets to the North Georgia Community Foundation (address provided below).
a) Completed application
b) Typed essay as outlined in Section VI
c) Two teacher recommendations and one letter of reference using the attached forms
Deadline: Complete application packets must be received by 5 p.m. on March 1, 2013.
Mail Application to:

Scholarships Manager
North Georgia Community Foundation
615F Oak Street, Suite 1300
Gainesville, GA 30501

Questions:

Call (770) 535-7880, ext. 226 or e-mail cflack@ngcf.org

By signing below, I certify that the information provided is complete and accurate to the best of my knowledge and is my
own work. I understand that falsification of information will result in termination of any scholarship granted. I understand
that late and incomplete applications will be disqualified.

Signature __________________________________________

Date ____________________

This application form consists of 5 pages. If you are missing any pages, please go to www.ngcf.org for the complete form.

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Jenny Melton Scholarship 2012-2013 Academic Year

JENNY MELTON SCHOLARSHIP


2013 TEACHER RECOMMENDATION FORM
Please submit recommendations from two teachers. Teacher recommendations should be included with your completed
scholarship packet.
Student Name: ____________________________________________________________________________________

Teacher Name: ____________________________________________________________________________________

School & Address: _________________________________________________________________________________


_________________________________________________________________________________
_________________________________________________________________________________

School Phone Number (include area code and extension): __________________________________________________

Teacher Signature: _________________________________________________________________________________

In a narrative format, describe the following (you may use this form or attach a separate sheet):
1. Excellence in the classroom
2. Your interpretation of why this individual is outstanding
3. The depth and breadth of your involvement with the nominee (e.g. how long you have known the nominee,
circumstances of your relationship, etc.)

This application form consists of 5 pages. If you are missing any pages, please go to www.ngcf.org for the complete form.

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Jenny Melton Scholarship 2012-2013 Academic Year

JENNY MELTON SCHOLARSHIP


2013 LETTER OF REFERENCE FORM
Please submit one letter of reference from an unrelated person. Your letter of reference should be included with your
completed scholarship packet.

Student Name: ____________________________________________________________________________________

Reference Name: __________________________________________________________________________________

Reference Address: ________________________________________________________________________________


________________________________________________________________________________
________________________________________________________________________________

Reference Phone Number: ___________________________________________________________________________

Reference Signature: _______________________________________________________________________________

In a narrative format, describe the following (you may use this form or attach a separate sheet):
1. The nominees effectiveness and contributions to the school/community
2. Your interpretation of why this individual is outstanding
3. The depth and breadth of your involvement with the nominee (e.g. how long have you known the nominee,
circumstances of your relationship, etc.)

This application form consists of 5 pages. If you are missing any pages, please go to www.ngcf.org for the complete form.