2021 Evangeline J. Sansome Scholarship
This is a needs-based scholarship for members of the 15th District PTA (through their high school) and must be applied to tuition only. APPLICATION OPENS ON DECEMBER 1, 2020 AND WILL CLOSE ON SUNDAY, FEBRUARY 28, 2021 BY 11:59 PM! Any applications submitted before or after these parameters will not be considered. Good luck to all applicants! Once an award is sent to the college or trade school of your choice, you will not be issued a new check until the original one is returned if you change schools. Winners will be required to submit photos and social security numbers for the purposes of reporting. If you have any issues submitting your scholarship application, please contact Gabriel Tilly at gabrieltilly@gmail.com with any questions.
Back
Next
Save
Student Information
Student Name
*
First Name
Last Name
Email (Make sure to periodically check this email for information.)
*
example@example.com
Student Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
High School
*
Please Select
Atherton
Ballard
Brown
Butler
Doss
duPont Manual
Fairdale
Fern Creek
Iroquois
Jeffersontown
Male
Moore
Pleasure Ridge Park
Seneca
Shawnee
Southern
Valley
Waggener
Western
Back
Next
Save
Parent Information
Father's Name (If Living)
First Name
Last Name
Father's Address (Type SAME if same as STUDENT)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Father's Employer & Occupation
Mother's Name (If Living)
First Name
Last Name
Mother's Address (Type SAME if same as STUDENT)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Mother's Employer & Occupation
Guardian Name (If Applicable)
First Name
Last Name
Guardian Address (Type SAME if same as STUDENT)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Guardian's Employer & Occupation
Back
Next
Save
PTA Information
*Membership is a requirement to be awarded a Scholarship. You may still join your school PTA, just contact your PTA president. *Membership is $5* If your school has no school PTA, please contact gabrieltilly@gmail.com for more information on how to become a member if you are not already or if you have any questions.*
Are you a PTA Member?
*
Yes
No
List the names, ages, and schools of all children in your household, including yourself.
*
Back
Next
Save
Academic Information
Please attach a Teacher's Email for us to reach out to (This MUST end in jefferson.kyschools.us)
*
Please attach a Counselor's Email for us to reach out to (This MUST end in jefferson.kyschools.us).
*
Please attach a Community or Religious Leader's Email for us to reach out to (This person can be a school club sponsor or coach).
*
Write a biographical sketch including the following (12 point font and double spaced): 1. Why you wish to attend college? 2. Why do you need a scholarship? 3. What field of work do you plan to enter/what you hope to do when you graduate from college? 4. List what honors or awards you have received. 5. What leadership opportunities you have had? 6. Service contributions or community involvement? 7. Employment, if any. 8. Clubs or organizations.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Save
Statement of Agreement
To the best of my knowledge, all of the information contained here in is accurate and true. By submitting this application and typing your name, you are giving permission to have your name appear publicly if you are awarded a scholarship. (All the information contained in this application will be considered personal and confidential.) You also state that your parent(s) or guardian(s) are fully aware of this application and are in agreement.
Student's Typed Name Signifying Agreement
*
Parent/Guardian Typed Name Signifying Agreement
*
Save
Submit
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm