AV研究所

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(845) 563-3400 124 Grand Street, AV研究所, NY 12550

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AV研究所 Free Academy Senior Scholarships Application

STUDENT INFORMATION
Student Name*	F: L:	Student ID*
Primary Home Address	Zip:	Grad Year
Email
Middle School Attended*		Counselor Name*
SAT Scores		ACT Scores

FAMILY INFORMATION
Name of Parent(s)/Guardian(s)
Occupation of Parent(s)/Guardian(s)
Estimated Gross(Total) Family Income
Number of children in family		Ages
Number of children who will attend college next year

FUTURE PLANS
Briefly describe your higher education and/or vocational goals

List college/trade schools you have applied to
List college/trade school you hope to attend:
What will you study*
If you are not going right onto college/trade school what is your plan?

FUTURE PLANS
How do you plan to pay your college/post-secondary tuition and (or) expenses? (Check All that Apply)
Grants Loans Other Scholarships Family/Savings Other:
What is your estimated college/trade school tuition?

Please list the scholarship/award money you have already received to date from colleges and or private scholarships

COMMUNITY SERVICE
ORGANIZATION	POSITION HELD	LENGTH OF INVOLVEMENT	TOTAL HOURS INVESTED

EMPLOYMENT HISTORY
LOCATION	POSITION HELD	LENGTH OF EMPLOYMENT	HOURS PER WEEK

HIGH SCHOOL EXTRACURRICULAR ACTIVITIES
Describe your extracurricular activities. Can include clubs, sports, societies, awards, etc. both inside and outside of school.
ACTIVITY	SPORT/CLUB/OTHER	GRADE LEVEL	LEADERSHIP ROLE/AWARD (If applicable)

HARDSHIPS
Sometimes a student鈥檚 application and achievements may be impacted by challenges or other circumstances. If you feel comfortable, you can circle any of the below topics that apply to you that have affected you academically.
Access to a safe and quiet study space Access to reliable technology and internet Community disruption (violence, protests, teacher strikes, etc.) Discrimination Family disruptions (divorce, incarceration, job loss, health, loss of a family member, addiction, etc.) Family or other obligations (care-taking, financial support, etc.) Housing instability, displacement, or homelessness Military deployment or activation Natural disasters Physical health and mental well-being War, conflict, or other hardships

REFERENCES
References can be any non-family member. This includes a teacher, counselor, administrator, employer, pastor, etc.
NAME	RELATIONSHIP	PHONE/EMAIL

PLEASE REVIEW ALL INFORMATION ENTERED ABOVE. BE SURE TO HIT "SAVE PROFILE" ONLY ONCE.