Herman Hoose Scholarship Application Checklist
Spring 2015
Dear Herman Hoose Scholarship Applicant:
This is a very exciting time in your school career! It is also a time when you are rushing to get
applications for college, scholarships, and financial aid completed and submitted by the allotted
deadlines. To properly complete the Herman Hoose application, you will need to do the
following:
1. Ensure you answer each and every question on your application.
2. Provide your Charlotte Metro Credit Union account number. (To be eligible for the Herman
Hoose Scholarship, you the applicant are required to be a member of the credit union and must
be the primary owner of your own account. Being a joint owner on a parent/guardian account is
not acceptable. If you do not have an account, you can apply online at www.cmcu.org or visit
one of our branch locations. You will need a valid photo ID and the $25 membership deposit.)
3. Letter of Acceptance from the institution you will attend.
4. Letters of Reference
5. Declaration of Career Goals
6. Current High School Transcripts (sealed)
7. Submit your completed application along with the above items by March 31, 2015.
All requested information must be included. Incomplete or late applications will be
disqualified.
Herman Hoose Scholarship Program
Sponsored by Charlotte Metro Federal Credit Union
In 2015, Charlotte Metro FCU will award ten (10) scholarships valued at $2,000 each to
eligible CMFCU student members.*
The scholarships are awarded to students who graduate high school in the current school year,
are current credit union members, and plan to enroll in an institution of higher learning in the
fall of the same year.
Applications will not be accepted for enrollment as part-time students, vocational, trade
schools, or for adult remedial education courses.
Completed applications must be received at the following address by March 31 of the current
year and must include all items requested in the checklist.
ATTENTION: SCHOLARSHIP COMMITTEE
CHARLOTTE METRO FEDERAL CREDIT UNION
718 CENTRAL AVENUE
CHARLOTTE, NC 28204
All applications are judged on a 100-point system:
0-30 pts
0-30 pts
0-10 pts
0-10 pts
0-15 pts
0-5 pts
Total 0-100 pts
Academic Achievement
Financial Needs
Declaration of Career Goals
Participation in Extracurricular Activities Related to School
Participation in Extracurricular Activities in the Community
Letters of Reference from teachers
*Scholarship funds will be sent directly to the institution the student will attend. In case of
tie(s), the CMFCU Scholarship Committee shall award based on financial need.
Herman Hoose Scholarship Application
Name:______________________________________________________________________
Account#:__________________________________
Date of Birth: ___________________
Name of Parent or Guardian:____________________________________________________
Address:____________________________________________________________________
City:__________________________________ State:________ Zip:___________________
Phone:________________________ Email:_______________________________________
Applicant is currently enrolled at:
High School Name:___________________________________________________________
Address:___________________________________________________________________
Other school attended, if applicable:
Name & Address:____________________________________________________________
Name and Address of college or university applicant will attend:
__________________________________________________________________________
__________________________________________________________________________
(Be sure to include a copy of your Letter of Acceptance)
Anticipated First Year Costs:
Tuition
$__________________________
Student Fees
$__________________________
Books and Supplies
$__________________________
Room and Board
$__________________________
Other
$__________________________ ( Explain if more than $500)
Family Financial Background:
Based on your parent/guardian 2014 Form 1040 Federal Income Tax Return:
What is the Total Income as listed on Line 22?
$____________________
What is the Adjusted Gross Income as listed on Line 35?
$____________________
Please describe any financial hardships which you would like considered.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Family Information:
List the name and ages of all other dependent children currently residing in your home and
claimed on above Federal Form 1040.
Name:___________________________________
Age:_____
Name:___________________________________
Age:_____
Name:___________________________________
Age:_____
Name:___________________________________
Age:_____
Academic Achievement:
Your cumulative high school grade point average is:_____________
Applicant currently ranks________ out of a class of _____________
(Be sure to include a sealed copy of your transcript)
List below the courses you are currently taking and the anticipated grade at the end of the
semester:
Course Name
Anticipated Grade
__________________________________
______
__________________________________
______
__________________________________
______
__________________________________
______
__________________________________
______
List any other academic achievements you feel are important to this application:
____________________________________________________________________________
____________________________________________________________________________
List other school activities in which you have participated:
____________________________________________________________________________
____________________________________________________________________________
List community activities, service organizations, etc. outside of school in which you have
participated and indicate any offices held:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Provide a declaration of career goals: (attach additional pages as necessary)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
List and attach Letters of Reference:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
I hereby grant permission to the Charlotte Metro Federal Credit Union Scholarship Committee
to verify all information submitted, or in support of, this application. I understand the decision
of the CMFCU Scholarship Committee and Board of Directors is final.
Applicant Signature:________________________________________________________
Parent/Guardian Signature:___________________________________________________
Mail or Deliver to:
ATTENTION: SCHOLARSHIP COMMITTEE
CHARLOTTE METRO FEDERAL CREDIT UNION
718 CENTRAL AVENUE
CHARLOTTE, NC 28204