HS Senior Apps

English Courses:

History Courses:

Language Courses:

Math Courses:

Science Courses:


Alworth Memorial Fund Home Page
Application for High School Seniors DEADLINE: January 15, 2010
Navigation Tips:
Use the tab key to navigate to a new field. If you accidently hit enter, click on the "back" arrow in the upper left hand corner to retrieve your work. Should you get an error page after submitting your application, click on the "back" arrow in the upper left hand corner to retrieve your work. Print a copy of your application before submitting. Our application does not allow you to save your work. If you exit the application you will not be able to retrieve your applcation. Upon submission, you will get an email (almost immediately) from our office informing you that we have received your application. If you do not receive this email, your application did not go through and you will need to fill out another application and resubmit.
Personal Information: Please use your "Tab" key to navigate to a new field. DO NOT USE THE ENTER KEY. All applicants must be a United States Citizen.
Last Name:		First Name:
Middle Initial:		Male Female
Address:		Phone #:	(enter numbers only)
City, State, Zip:
E-mail:
County	*You must have graduated from a high school in one of these counties to be eligible.
High School
Graduation Date:
Which college or University do you plan to attend next year?
City, State:
Intended Major Field of Study:
Course Length in Years:
Your age, last birthday:
Date of Birth:	Place of Birth:
Father's Name:		Father's Age:	Deceased
Father's Occupation:
Father's Home Address:		Business Phone:	(enter numbers only)
Mother's Name:		Mother's Age:	Deceased
Mother's Occupation:
Mother's Home Address:		Business Phone:	(enter numbers only)
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 and whether they are a Freshman, Sophomore, Junior or Senior.

Budget Information: The table below outlines a budget of your year at college. Complete it carefully with the help of a parent, guardian, or counselor. If you plan to live at home, omit completely the item of room and board either as an expense or contribution of parent or guardian. Enter whole numbers only, no commas, periods or dollar signs. For example, type 1250, not $1,250.25.

EXPENSES		RESOURCES
Tuition and fees:	$	From savings or investments:	$
Room and board:	$	From parents or estate:	$
Transportation:	$	From part-time work:	$
Books and supplies:	$	From tuition grants/incentives:	$
Incidentals:	$	From other scholarships:	$
Clothing:	$	From loans:	$
		From other sources:	$
Total Expenses:	$	Total Resources:	$
		Needed to balance budget:	$

If you have had employment, please list:
Employer	Type	Dates	Hours Per Week

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.):

High School Activities (check all that apply):

	9	10	11	12
Student Council/Government
Class Officer
National Honor Society
Green Club
Key Club
AFS
Debate Team
Speech Team
Band
Orchestra
Choir
Drama
School Newspaper
Yearbook
Literary Magazine
Math Team
Knowledge Bowl
Mock Trial
Peer Helper/Mediator/Tutor
School Spirit Committee/Group
Prom Committee
Junior Rotarian
Other 9 10 11 12

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: Note: Applicants will be considered by the Board of Directors only if IRS income tax information is included in this application process. Eligible candidates must be from families whose taxable income is less than $120,000. Ask your parents to email (alworth@cpinternet.com), fax (218-529-3760) or send by US Postal Service (Alworth Memorial Fund, 306 W Superior Street, Suite 402, Duluth, MN 55802)a copy of their most recent (2008 or 2009) IRS 1040 pages 1 & 2. In the event of divorce or separation, the IRS 1040 of the parent who provides more than 50% support will be used to determine financial need. If neither parent provides more than 50% support, the IRS 1040 of the parent that the applicant lives with will be used.

Do you live with a step parent?	Yes No
Do you live with a single parent?	Yes No

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. For example, enter 1.5 not 1 1/2. Do not leave any boxes blank, enter either a number or a zero.

	Regular	Honors	AP	CITS	PSEO	Other
English
Literature
Composition
Other English Courses

American History
World History
American Government
Economics
Civics
Other History Courses

French
German
Spanish
Other Foreign Language Courses

Algebra I
Algebra II
Algebra III
Geometry
Trigonometry
Pre-Calculus
Calculus
Calculus II
Statistics
Other College Prep Math

Computer Science
Biology
Physics
Chemistry
Anatomy/Physiology
Physical Science
Zoology
Other Sciences

Please define any course taken for which you entered credit(s) in the "Other" courses column above.

If you are a PSEO or CIS student (i.e. a student who is taking college courses while in high school)

For PSEO Credits, list the college(s) you have attended.
If your college credits do not show on your high school transcript, please send us a college transcript.

What is the size of your graduating class?

(enter numbers only)

What is your rank in the class?

What is your high school grade point average?

Final Question:

Briefly tell us in 200 words or less; Why do you think that you should be selected for this scholarship?

Letters of Recommendation:

Each applicant is asked to request two letters of recommendation from faculty members at school (such as a counselor or administrator; include at least one science or math teacher in this group). List the Name, Title and Subject Taught of your references below.

Provide the date you requested your High School counselor or guidance secretary to send a copy of your cumulative record to the Alworth Memorial Fund office:

Print Copy of Application:

To print a copy of your completed application for your records, click the Print Completed Application button. Then click the print button on the toolbar of the window that opens.

How did you learn about the Alworth Memorial Fund Scholarship opportunity? Check all that apply.

Counselor/Teacher
Website
Poster
Flyer
Friend
Parents/Family Member
Alworth Representative
Newspaper/Printed Media
Other

All the information submitted on this form constitutes my application for the Marshall H. and Nellie Alworth Scholarship and is correct and true to the best of my knowledge and belief. I understand that all information furnished to the board of Directors shall be kept confidential.

Note: Because this is an online application, you must check the box below, which is the equivalent of your signing a paper application form.

I am submitting my application via the Alworth Memorial Fund website. The checked box constitutes my signature affirming the information is correct.

Print a copy of your application before submitting.

Upon submission , you will get an e-mail (almost immediately) from our office informing you that we have received your application. If you do not get this e-mail, your application did not go through and you will need to fill out another application and resubmit.

Should you have any questions or problems submitting your application you may e-mail Patty Salo Downs, Executive Director, at alworth@cpinternet.com or call 218-722-9366.

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