Scholarship Applying For:
____ Undergraduate Student
____ College Senior or Graduate Student


Personal Information:
Name______________________________ College or University_______________________________________
Address____________________________Telephone______________________
City_______________________________ State__________ Zip code__________


Education
List any schools previously attended starting with your high school
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What is your planned Field of study
__________________________________________________________________________________________

What is your status(circle)- single or married
If married what is your spouse’s name________________________________
Do you have children?  If so what ages_______________________________
Are you considered a dependent__________

If you are a dependent, complete the following:
Father’s Name________________________
Father’s place of employment and position held____________________________________________________
_________________________________________________________________________________________

Mother’s Name________________________
Mother’s place of employment and position held___________________________________________________
_________________________________________________________________________________________

List all dependent children in your parent’s home(Name, age, school/ work)
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

All applicants complete:
Are you presently working?_______ If yes, where?__________________________________________________
_________________________________________________________________________________________

What is your position?_______________________________________________________________________
Approximate earnings?______________________________________________________________________
Other financial responsibilities?________________________________________________________________
_________________________________________________________________________________________

List any jobs you have had in the past 2 years_____________________________________________________
________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________

Please complete the following information, which will be held in strict confidence.

Dependents:
a. Family’s total combined IRS Adjusted Gross Income:
_______under $30,000     _______$76,000-$100,000
_______$31,000-$50,000 _______Over $100,000
_______$51,000-$75,000

All Applicants:
b. Your, or if married, you and your spouse’s combined IRS Adjusted Gross Income
_______under $5,000     _______$15,100-$25,000
_______$5,100-$10,000 _______Over $25,000
_______$11,000-$15,000

c. Briefly describe any circumstances of which the committee should be aware in order to help them make their selection. (i.
e. children, illness, medical, dental expenses, etc.)
_________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

d. Check other sources of income from which your education may be financed. ____Personal Savings ____Work
____Help from family ____Scholarships ____Loans
____Other sources

Personal Scholarship Statement:

Please use the following outline to write a, 1 to 2, page paper to let the committee know who you are. You may write it in list
form, or if you prefer, in essay form. Please double space.

Educational Goals:

Career Goals:

Personal Goals:

Special Interests:

Financial Need:

What are your campus activities? What do you like to do?

What environmental activities have you been involved with? Volunteer or work related.

Signed____________________________________________________________
Date__________________________

Send to: Berkley Fishing Team Environmental Scholarship
9910 Gerdanville  Ave. SE
Waynesburg, Ohio  44688

If you email the application, sign with the following:
Printed Name________________________________ email address______________________
Date_______________
Email to: j.groff@neo.rr.com

Required Materials:   
 
  • Application with essay attached
  • 2 letters of reference
  • copy of your transcript
The Berkley Fishing Team Of Ohio Environmental Scholarship Application
Please copy and paste into an email or document software.
Copyright 2015 Berkley Fishing Team of Ohio Inc.