APPLICATION FOR SCHOLARSHIP
(Deadline:  Sunday, April 7th, 2019, 5:00 o’clock p.m.)

PLEASE PRINT IN BLACK INK OR TYPE

Student’s Last Name:	______________________________________________________

First Name: __________________________________  Middle Initial: ___________________

Address: ______________________________________________________________________
	      (Street Address)				      (City)		(State)		(Zip)

Student’s Social Security Number: _____________________________ (Must Provide Copy of Card)

Student’s Birth Date: ______________  Ethnicity [Please Circle One]: (White) (Black) (Hispanic) (Other)

Student’s Email: ______________________________ Cell: _____________________________

Parent’s Name: _________________________________________________________________

Day Time Phone Number: ______________________ E-Mail Address: ____________________

Student’s School Name: __________________________________________________________

School Address: ________________________________________________________________
		      (Street Address)			      (City)		(State)		(Zip)

School Telephone Number: _______________________________________________________

School Counselor(s) Name: ___________________________ OR ________________________

Student’s Overall GPA: __________________  No. of Students in Graduating Class: _________

Student’s Class Ranking: _________________________________________________________

IMPORTANT:  PLEASE PROVIDE AN OFFICIAL COPY OF YOUR 
CURRENT HIGH SCHOOL TRANSCRIPT WITH THIS APPLICATION.

Family Income Information: Documentation must be provided to meet income requirements.  (Tax Return for year 2018).  This will be used for determination of scholarship qualification purposes and distributed to Magnus Charitable Trust Directors, advisors, and judges.

Single Parent Household Income: _________________________________________ (Per Year 2018)

Additional Income: _____________________________________________________  (Per Year 2018)

Dual Parent Household Income: ___________________________________________  (Per Year 2018)

Additional Income: _____________________________________________________  (Per Year 2018)

Number of Adults in Household: __________ Number of Children in Household:  ___________

Full Name of Adult(s):  ___________________________________________________________

Name, Address, and Telephone Number of Accepted and Selected Educational Institution:

Name: ________________________________________________________________________

Address: ______________________________________________________________________

Telephone No.: ____________________ Financial Aid Telephone No.: _____________________

Assigned Financial Aid Counselor or Contact Name: ____________________________________

Have you received a scholarship from university? _________________ 

YOUR SIGNATURE HEREIN BELOW SERVES AS YOUR ACKNOWLEDGMENT THAT YOU HAVE READ AND RECEIVED THE ATTACHED RULES PERTAINING TO THE SCHOLARSHIP APPLICATION PROCESS FOR THE MAGNUS CHARITABLE TRUST, AND THAT ALL OF THE RESPONSES ON THIS FORM ARE CORRECT AND THAT YOU AGREE TO ALL OF THE RULES PERTAINING TO THIS APPLICATION.  

__________________________________________________	________________________
		   (Student’s Signature)					 	    (Dated)

__________________________________________________	________________________
		   (Parent’s Signature)					        	    (Dated)