Junior Service League Scholarship Application
Biographical Information
Full Name
First and Middle
Last Name
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Social Security #
Please enter a valid phone number.
Date of Birth
-
Month
-
Day
Year
Date
Marital Status
Please Select
single
married
separated
divorced
Sex
Please Select
female
male
other
Name of High School (must be a graduating senior)
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Financial Information
Father/Mother and/or Guardians
Father or Male Guardian Name
First Name
Last Name
Age
Marital Status
Please Select
single
married
separated
divorced
widowed
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Present Employer's Name
Type of Business of Employer
Years at Current Job
Position at Current Job
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Financial Information
Father/Mother and/or Guardians
Mother or Female Guardian Name
First Name
Last Name
Age
Marital Status
Please Select
single
married
separated
divorced
widowed
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Present Employer's Name
Type of Business of Employer
Years at Current Job
Position Held at Current Job
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Household/Dependent Information
Are your parents married, divorced, or separated?
Please Select
married
divorced
separated
widowed
If divorced or separated, whom do you live with?
Do both parents contribute to your financial well being?
Please Select
YES
NO
List all children, including applicant
Name of children:
Name of Present School
Year in School
Last Year's Tuition (exclude board)
Age
YES/NO if currently living with parents
.
.
.
.
List any other dependents receiving financial support from parent/guardian:
Name of Dependent:
YES/NO if living with parent or guardian
YES/NO if dependent for tax purposes
Age
Relationship to Student
.
.
.
.
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Income Information
***Whenever information is requested for father or mother, provide information for Father/Stepfather/Male Guardian and/or Mother/Stepmother/Female Guardian***
Please fill in if applicable:
FATHER
MOTHER
APPLICANT
Salary (wages)
Pension or Retirement Income
Dividends and Interest Income
Social Security benefits or SSI
AFDC,ADC, or other public assistance
Unemployment compensation
Disability benefits
Veteran's benefits
Alimony
Child Support
Other (please explain)
TOTAL INCOME:
Asset Information (please give values):
FATHER
MOTHER
APPLICANT
Cash, checking, savings, and credit union accounts
Home (if owned)
Other Real Estate
Stocks/bonds
Other investments - educational
401K, retirement, profit sharing, pension funds
Business value
Automobiles
Debt Information (please give values):
FATHER
MOTHER
APPLICANT
Home mortgage balance
Other Real Estate mortgage balances
Automobile loans
Business Debt
Credit Cards
Other unsecured debts/installment payments
Other - explain
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Scholastic Achievement
I. Scholastic Recognition: Comment on any recognition for scholastic achievement that you have received:
II. Tuition and Financial Aid: A. Schools planning to attend next year
Name of School:
YES/NO Have you been accepted?
Tuition Cost Per Semester:
Cost of Room and Board Per Semester:
First Choice:
Second Choice:
B. Why did you select these schools?
C. What are your future goals?
D. List any scholarships, grants, gifts, etc. already received by applicant:
E. List other scholarships, grants, gifts, etc. which applicant has already applied:
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Service to School and Community
(Service does not mean honors or awards by school or community.)
Describe you service to your school:
Describe you service to your community:
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Applicant's Work Experience
Describe applicant’s work experience during summer and school year:
Documents
Please upload all required documents: Page 5 & Page 6 from official application packet posted on JSL website or received by guidance counselor, Official High School Transcript, and 3 letters of recommendation.
Page 5, Page 6, and Official Transcript
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3 Letters of Recommendation
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Please follow all directions in application packet very closely to ensure all areas are completed correctly and all documents are uploaded (& signed appropriately by school staff). If any documents or areas are missing, then the application will be discarded.
Applicant Signature
Email
*
example@example.com
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