Dylan Jeffries Annual Scholarship Application Form Scholarship Preference-YOU MUST SELECT A CATEGORY TO BE CONSIDERED (circle) Four Year College/University Identify above_________________________ Two Year College Trade/Technical/Business School Institution Contact number_____________________________ Intended major or area of concentration______________________________________________ High School Currently Attending____________________________ County_____________________ Name: Last First Middle Address: Street City State Zip Telephone Number _____________________ Email Address _________________________________ Social Security Number ______________________________ Date of Birth _______________________ Father's or Guardian's Name: ____________________________ Occupation _______________________________ Employer __________________________________ Mother's or Guardian's Name:____________________________ Occupation _______________________________ Employer __________________________________ Combined/total family income____________________________ Name of High School: _________________________________ Grade Point Average: _______________ (transcript must be attached). Please list any course work taken in the following areas during high school: Honors Course Work: Advanced Placement (AP) Course Work: College Classes: Trade/Technical/Business School Classes: List membership and participation in school organizations and activities including, positions of leadership held, if any. Please do not abbreviate club and organizational names. (If extra space is needed, please use another sheet and attach.) List school or civic honors, awards or recognition. (If extra space is needed, please use another sheet and attach.) (Continued p 2) Work Experience: Most Recent Employer _______________________________ Phone ________________________ Position _______________________ Employed From____________To _______________ Please describe in a brief essay (200 words or less) why you feel you should be the recipient of this scholarship. Include any unusual family circumstances. (If more space is needed, please use another sheet and attach.) RETURN APPLICATIONS AND ALL SUPPORTING MATERIAL TO SUNNY CROFT COUNTRY CLUB, ATT. SCHOLARSHIP COMMITTEE, P.O. BOX 966, Clarksburg, WV 26302-0966 Deadline for submission is April 15, 2015. Recipients will be notified by May 1, 2015. Scholarships will be awarded at the recipient’s respective school during their award ceremonies in May prior to graduation. Cover letter must be attached to this application for scholarship consideration. Any false information or misrepresentation made by the applicant shall result in immediate revocation or termination of scholarship. I certify that the information I have provided in this application is complete and accurate to the best of my knowledge. Signature of Applicant Date