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Friends of Wilson Lake David Prince Memorial Scholarship Application

Complete the following application form, short essay and include your high school transcript. All forms must be submitted to the Mt. Blue High School Guidance Office by the last Friday in April. Students will be notified at the MBHS Awards Assembly. Award will be applied to the second semester tuition payment. Name: __________________________________________________ Class Rank: ______________ Address: _____________________________________Town: _______________ Postal Code: _______ Phone: _____________________ Email: ________________________________________ Name of parent(s) or guardian with who you reside: __________________________________________ Parent(s)/Guardian(s) occupations and employers: _____________________________________________________________________________________ _____________________________________________________________________________________ Ages of siblings/step siblings: ___________________________________________________________ Total number of people living in the home: _______ Total number of household members attending college next year (include yourself): _____________ College/School you will attend: __________________________________ Location: ______________ Possible major/minor program of study: _________________________________________________ Current career goals: _________________________________________________________________ Total financial aid awarded from college: ________________________ Other: __________________ Estimated costs of college for next year:

Tuition: ________________ Room and board: _______________ Fees: _______________ TOTAL: _________________

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Friends of Wilson Lake David Prince Memorial Scholarship Application Work Experience (list employer, position and dates of employment) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Extracurricular Activities (include school, community service, leadership roles, awards) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Essay – attach an essay of less than 250 words (typed) explaining why you should be granted this scholarship. Check off items included:

___ 1. Completed application form ___ 2. Essay of 250 words or less ___ 3. Official high school transcript

Applicant signature: ___________________________________

Date: _____________

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Scholarship application form 2014