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Scholarship Application Form
Application Deadline: May 1, 2015
2015 Scholarship Application Checklist
PLEASE READ CAREFULLY AND CHECK OFF ALL THE ITEMS BELOW BEFORE
SUBMITTING APPLICATION. INCOMPLETE APPLICATION PACKAGES WILL NOT BE
CONSIDERED BY THE REVIEW COMMITTEE.
PERSONAL/FAMILY INFORMATION
SCHOLASTIC INFORMATION
CURRENT HOUSEHOLD INCOME
COLLEGE/SCHOOL INFORMATION
ATHLETIC/SCHOOL/COMMUNITY ACTIVITIES
WORK EXPERIENCE
ESSAY
REFERENCES (AT LEAST TWO)
SIGNATURE AND ACKNOWLEDGEMENT
TO THE APPLICANT:
PLEASE READ ALL PAGES CAREFULLY BEFORE FILLING OUT THIS FORM:
By fully completing this application, you will help us determine your eligibility to receive
a scholarship.
• You must complete each section of the application.
• You must have a school official complete the required scholastic
information and include two letters of reference. You are encouraged
to select a school or college counselor or teacher, minister, employer
or job supervisor as a reference; someone who knows you well and is
in a position to evaluate you according to the criteria given.
• If any questions are not applicable to your current situation, please
attach an explanation referring to the questions by sections. If you
need more space for any item, you may attach additional pages. Please
indicate appropriate sections.
• You are responsible for seeing that all supporting documents are
submitted. The Realtor® Association Scholarship Committee
reserves the right not to process applications found to be incomplete
as of the application postmark deadline.
APPLICATION DATA
Applicant's Name:
Permanent Street Address:
City, State, Zip:
Telephone #:
Cell Phone #
Your personal e-mail address:
Date of Birth
Month/Day/Year
I. PERSONAL/FAMILY INFORMATION
Are you a RASM Member or immediate family member of a RASM
Member (this includes spouse of a member or the son/daughter of a
Member)? 0Yes 0No (If applicant is a minor, please indicate which
applies. If you are a SAR Member the information should reference your work
information, etc.)
I live with my 0 mother 0 father 0 both parents 0other guardian
Name of parents/guardian:
N/A
Address if different from above:
Phone #:
Father’s employer:
Position:
Work Address:
Work phone #:
Mother’s Employer:
Position:
Work Address:
Work phone #:
II. SCHOLASTIC INFORMATION - Please have this section completed by an appropriate school
official. Remember to include an official transcript, including SAT and/or ACT scores with this
application. You may at your option include the writing portion of the SAT or ACT scores.
Applicant ranks
in a class of
List Grade Point Averages Below:
GPA Freshman year
GPA Junior year
GPA Sophomore year
GPA Senior to date
SAT WRITING:
ACT WRITING:
SAT Verbal
ACT English
SAT Math
ACT Math
ACT Composite
Highest Education Level completed
Where:
When:
I certify this data is from a current and official transcript.
Name and Title
Telephone Number
Date
III. CURRENT HOUSEHOLD INCOME (Parents/legal guardian or RASM Member of minor child must fill
out this portion)
A.
How many people reside full time in your household? (*full time is more than 180
days in a calendar year.) (please fill in number)
Adults___
Children
B.
What is your current, major source of income? (Please check those that apply)
Alimony/Child Support
Employment
Public Assistance
Self Employed
C.
Do you have other children currently attending college?
If so, what college does he/she attend?
Social Security
Spouse - Partner
Unemployment
Other (please explain)
0Yes
0No
D.
Please explain or share with the Committee any circumstances or financial information which you
believe would be helpful to the Committee in assessing your financial need. All information is kept confidential
and is considered only by the Committee for the year in which this application is received. (You may use a
separate sheet, if necessary.)
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IV. COLLEGE/SCHOOL INFORMATION - (Please include copies of official acceptance if
available)
College/University/School choice:
College/University/School mailing address:
04 yr. College/University 0Community College 0Vocational/Technical 0Other:
Accredited? 0Yes 0No
Intended major/vocational choice:
Student will live: 0On campus 0Off campus 0Will commute 0Student is enrolled (provide credit hours
per semester)
Anticipated starting date:
Anticipated graduation date:
ESTIMATED COLLEGE/SCHOOL EXPENSES - (Please use school data or information from your
financial aid package. Budget should be for one full year of expenses and resources).* If no credits will be
taken during the summer recess, please reflect same. It is important that you fill in all this information to the
best of your ability.
BUDGET for the period from
to
Any time applicant will not be in College/University/School please note here:
Estimated Annual Expenses
Estimated Annual Resources
Tuition & Fees
Books & Supplies
Room & Board
Personal Expenses
Transportation
$
$
$
$
$
Loan/gifts (family, friends)
Other (list)
$
$
TOTAL ANNUAL BUDGET:
$
$
$
$
$
Student contribution
V.A. or S.S. Benefits
Loans
Other Financial Aid
(Work Study, etc.)
*Other Scholarships/Awards $
Other Resources (list)
$
$
TOTAL ANNUAL RESOURCES:
$
Will you be able to receive financial support from your parents to attend college? 0Yes
Do you anticipate receiving other scholarships?
0No
0Yes 0No
If so, please list name/type of scholarship & amount separately *Total should be included in Other
Scholarships under Estimated Resources. Prior to receiving an official response from RASM o n this
application, we ask that you please notify the Association if you receive official notification t h a t yo u
h av e b ee n a w ar d e d a n y o t h e r scholarships.
Name of Scholarship
Award Amount
Granted
Pending
V. ATHLETIC EXPERIENCE, SCHOOL, & COMMUNITY ACTIVITIES - Please detail your
athletic achievements and any other activities you have been involved with during the last 5 years that you feel
are significant. This could include clubs, church activities, and unpaid internships, etc.
Activity
# of
Years
Special Awards
VI. WORK EXPERIENCE - Please describe any paid work experience, including summer jobs.
Position
Date From
(mo/yr)
Date To
(mo/yr)
Hours
Per Week
Amount
Earned
Please report any unusual family or personal circumstances you feel we should c o n s i d e r .
VII. ESSAY - Please write an essay of 200-300 words, introducing yourself, identifying your mentors, sharing
your goals and expectations and describing why you should receive a scholarship. Print clearly in pen or add a
typed insert.
VIII. REFERENCES - Please ask two people, who know you well to write letters of reference. Appropriate
people to ask include coaches, recent teachers, your school advisor or counselor, employer, minister, etc. (A
friend, neighbor or family member is not an appropriate reference). This application will not be considered
complete unless these letters are included with your application. Letters must be written within the last twelve
(12) months.
Letters of reference should include:
1. Name, address, and phone number of the letter writer.
2. First and last name of the student about whom the letter is written.
3. How long he/she has known the applicant and in what context.
4. Description of the applicant’s character, achievements, and ability to set realistic and attainable goals.
List the names, addresses and phone numbers of persons who have written your letters of reference:
1.
Name:
Address:
Street Address
City
State
Zip Code
City
State
Zip Code
Telephone Number:
2.
Name:
Address:
Street Address
Telephone Number:
IX. CERTIFICATION AND ACKNOWLEDGEMENT
By signing below, I acknowledge that the information contained in this application is true and correct to the best of my
knowledge and that I will inform the Scholarship Committee of any material changes which might occur in this
information up through the date of issuance of any award.
Applicant's Signature
Date
Signature of Parent/Guardian
Date
NOTE: Completed application must be received no later than May 1, 2015.
Realtor® Association of Sarasota and Manatee
Attn: Scholarship Committee
2320 Cattlemen Road, Sarasota, FL 34232