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Alworth
Memorial Fund Home Page |
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Application
for High School Seniors
DEADLINE: January 15, 2009
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- Use the Tab Key to navigate to a new field. If you accidentally hit enter, click on the "back"
arrow in the upper left hand corner to retrieve your work.
- When entering your expenses,
enter round numbers only. Do not
use commas, periods, symbols or dollar signs. For example, type 1250, not $1,250.25.
- When entering your academic
information do not use any fractions, enter numbers and decimal points
only. For example type 1.5 credits,
not 1 ½.
- Should you get
the error page after submitting your application, click on the "back"
arrow in the upper
left hand corner to retrieve your work.
- You will get an
email confirmation from our office informing you that we have received
your application. If you do not get
the email confirmation, you will need to submit another application.
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Please use your "Tab" key to navigate to a new field. DO NOT USE THE ENTER KEY.
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| Last Name: |
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First Name: |
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| Middle Initial: |
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Male
Female |
| Address: |
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Phone #: |
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| City, State, Zip: |
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| E-mail: |
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| County |
*You must have graduated from a high
school in one
of these counties to be eligible. |
| High School |
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| Graduation
Date: |
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| Which
college or University do you plan to attend next year? |
| City, State: |
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| Intended
Major Field of Study: |
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| Course Length in Years: |
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| Your age, last birthday: |
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Date of Birth: |
Place of Birth: |
| Father's Name: |
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Father's Age: |
Deceased |
| Father's Occupation: |
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| Father's Home Address: |
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Business Phone: |
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| Mother's Name: |
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Mother's Age: |
Deceased |
| Mother's Occupation: |
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| Mother's Home Address: |
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Business Phone: |
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Please list
the names and ages of your brothers and sisters. If any of your
siblings are now attending college, please indicate the name of
the college.
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If you are applying, or intend to apply, for
any other scholarships, aid or grants, please list them:
List your Community Activities (church,
scouts, 4-H, theatre, music, volunteer work, leadership roles, etc.):
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HIGH SCHOOL ACTIVITIES (Check all that
apply):
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For the Activities listed above provide Leadership Role information (ie. Yearbook Editor, Band Section Leader):
Varsity Athletics
- List the sports and year in which you have participated. Include leadership roles (ie. Soccer Captain):
Other Activities
- List the Activity and Year. Include Leadership Roles. :
List all honors,
awards, or special recognitions you have received during grades 9-12. Please
respond freely and completely.:
Financial Information:
The Board of directors consider
financial need in determining awards.
Please respond to the questions below.
Note: Eligible candidates must be
from families whose taxable income is less than $100,000.
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| Do you live with a step
parent? |
Yes
No |
| Do you live with a
single parent? |
Yes
No
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Important: Ask your parents to email (alworth@cpinternet.com), fax (218 529-3760) or send by US Post a copy of their most recent IRS 1040, pages 1 and 2, to our office by January 15. If mailed, send to:
Alworth Memorial Fund
306 W Superior Street
Suite 402
Duluth, MN 55802
Please Note: Applicants will be
considered by the Board of Directors only if IRS income tax
information is included in this application process.
If your parents do not
file with the IRS,
please explain.
Academics:
Using one year of study as an indicator of
one high school credit, list in the boxes below the number of high school
credits you will have completed in grades 9-12 by the time you graduate.
Enter numbers and decimal points only (no fractions). Do not leave blank (must be zero).
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Please define any courses taken for which you entered credit(s) for "Other" Courses:
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If you are a PSEO or CIS student (i.e. a student who is taking college courses while in high school)
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For PSEO Credits, list the
college(s) you have attended.
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If your college credits do not show on your high school transcript, please send us a college transcript.
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