BPW/NC
FOUNDATION SCHOLARSHIPS APPLICATION
NAME:__________________________________ SOCIAL
SECURITY#:_____________________
ADDRESS:______________________________
PHONE#:_______________________________
CITY:____________________________________ STATE:_________ ZIP__________________
PERSONAL
DATA
DATE
OF BIRTH: __________________
MARITAL STATUS: Single____ Married_____ Divorced_____ Widowed_____
CHILDREN?: Yes_____ No_____ If yes, how many?_____
Names and ages:
(1)_____________________age____ (2)_____________________age_____
(3)_____________________age_____
(4)_____________________age_____
(5)_____________________age_____
(6)_____________________age_____
EMPLOYED?:
Yes_____ No_____
If yes, employer:_____________________________________________________
Address:
State:________
Zip______________
Will you continue to work while enrolled?: Yes_____
No_____
EDUCATIONAL INFORMATION (Institution you will be attending)
Name of Institution:
________________________________________________
Classification: Fresh._____ Soph._____ Junior_____ Senior_____
Enrollment status: Full-time_____ Half time_____ Less than Half-Time_____
Degree: AA/AS_____ BA/BS_____ MA/MS_____
PHD_____ Other_____
Major:_____________________________
Expected Graduation date:____________
Annual Tuition & Required Fees:
$______________
BPW/NC
Foundation Scholarship page 2…
Applicant’s
Name:_______________________________________________________________
FINANCIAL
DATA
Number in your household:__________ Number in
College:__________
Annual Income:
You $_______________
Your spouse, if applicable $_______________
Your parents, if applicable $_______________
Expected Resources for School:
From family (yourself, spouse, parents) $_______________
From friends or relatives $_______________
From savings $_______________
From other financial aid $_______________
PERTINENT
INFORMATION
ATTACHMENTS:
Ø
Most recent grade transcript
(high school or college, whichever is applicable)
Ø
Two letters of Reference: 1
Educational ~ 1 Personal
Ø
Summarize your
career goals, previous honors or community activities and justify your
need for
this scholarship (1 page or less)
Ø
Make 3 copies
of this application and requested attachments
Mail application and attachments to:
Mary Lou Babinski
BPW/NC Scholarship Chairman
10908 Brandonwood Lane
Matthews, North Carolina 28105
Questions: call 704.545.3717
APPLICATION DEADLINE: APRIL
15