Jay Entertainment & Music Society

2010 Carlos Straight Memorial Scholarship Application
Deadline for 2010 - May 1, 2010

Student's Full Name ________________________________________________________
                             (first)                                          (middle)                                        (last)

Address _________________________________________________________________________
                        (street)                                                     (city)                                       (zip code)

Parent/Guardian
Father
_________________________________________________Occupation________________

Mother _________________________________________________Occupation________________

Student's Date of Birth ____________________________________

Number of Brothers & Sisters _____________Number in College ________________

Anticipated Date of Graduation _________________Field of Study ___________________

Are you attending Full Time _______________

High Schools Attended (Grades nine through twelve)
                                           School                                             Date of Entrance               Grades Attended

_______________________________________       ________________      ________________

_______________________________________       ________________      ________________

Name of the College you will be attending                                                                   Total Cost Per Year

__________________________________________________________     ________________

What will you major in? _________________________________________________________

Participation in Extra Curricular Activities  -  Indicate Year

__________________________________________________________      ________________

__________________________________________________________     ________________

__________________________________________________________     ________________

__________________________________________________________     ________________

__________________________________________________________     ________________

Out of School Activities

__________________________________________________________     ________________

__________________________________________________________     ________________

__________________________________________________________     ________________

Awards

__________________________________________________________     ________________

__________________________________________________________     ________________

Financial Aid Information

A.  Father's total annual earned income after taxes  ____________________________

B.  Mother's total annual earned income after taxes ____________________________

C. Amount Reserved for College Eduation of Applicant  _________________________

D. Number of Dependents (excluding Father & Mother)_________________________
Have you been granted scholarship aid?  If so, explain
 

___________________________________________________________________________

Do you expect?  If so, write in the amounts  -  Pell ________ SEOG ________TAP ________
College Aid _______

Will you apply for a Guaranteed Student Loan? _____________  How much? ______________

How much have you saved ____________________________

Please state in 200 words or less (written on the back of this application) your reasons for applying for this scholarship.  Be specific as to your needs.  (Please write legibly in your own handwriting or type)

 

Signature of Applicant ______________________________________________________