South
Shore Foundation Academic Scholarship Application
| Only
students who are attending a South Shore area high
school are eligible for this $1,000 scholarship. This
includes students who are graduating or have graduated
from Flippin, Yellville-Summit, Lead Hill, Omaha, Bruno-Pyatt
and Bergman. |
Deadline:
March 31st
Turn in your application to your High School counselor. High
School counselors must notify the South Shore Foundation of
the winner by April 15th.
Transcript Deadline: July 31st (for renewing
scholarship recipients) Send complete transcripts to the South
Shore Foundation c/o Deanna Sullivan/NATCO P.O. Box 209 Flippin,
AR 72634.
| Scholarship
Application - Graduating Seniors and/or
Students Renewing Scholarships |
Student
Name: ______________________ Parents
Name: ______________________
| _______
- _______ - _______ |
________ |
________ / ________ / _________ |
| Social
Security Number |
Age |
Date
of Birth |
Permanent
Address (Parents or Student): ____________________________________
City: _____________________________ State:
________________ Zip: ________________
State
& County of Legal Residence: __________________________________________________
| ___________________ |
___________________ |
| Home
Phone # |
Cell
Phone # |
Today's
Date: _____ / _____ / ______ South
Shore High School:_______________
College
Expected to Attend: _______________________________________________
College Address: _____________________________________
City: _____________________ State: __________________
Zip: _______________
Major: _____________________________________________________________
Expected Date of Graduation: _______________
High School
College
Estimated cost per semester: Tuition & Fees
_________________
Room & Board ___________________
_______________________ ___________ ___________________ ____________
High School Grade Point ACT
Scores SAT
Composite Score
College GPA
Average (From Transcript) (Highest)
(Highest)
Seniors:
*Enclose a Current Official High School Transcript
& ACT/SAT Scores.
*Enclose Proof of Admission to College,
if Available.
*Students
Renewing Scholarships: enclose a current complete college transcript.
Will
you be employed while attending college?: _____________
Employer:
___________________________________________
Phone #: ___________________
Number of
hours worked per week: _________________
| Extra
Curricular Achievements |
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Have
you received or are you going to receive any other scholarships?
yes_____ no_____
Please list with $ amounts.(Do not include loans or work study
information)
| ___________________ |
___________________ |
$_________________ |
| Title
of Scholarship |
Source
of Scholarship |
Amount/year |
| ___________________ |
___________________ |
$_________________ |
| Title
of Scholarship |
Source
of Scholarship |
Amount/year |
| ___________________ |
___________________ |
$_________________ |
| Title
of Scholarship |
Source
of Scholarship |
Amount/year |
Write
a letter from yourself stating your need for this scholarship,
plans for your education, and
your future career.
The
South Shore Academic Scholarship Financial Statement
The
Financial Statement of (parent's or guardian name or student's
name):____________________
Address:
__________________________________________________________________________
Telephone
Numbers - Home: __________________________ Cell:
__________________________
RE:
Application of: __________________________________________________________________
(Name
of Student)
