2023 COLEMAN-LOWER SCHOLARSHIP

COLEMAN-LOWER SCHOLARSHIP

ELIGIBILITY CONFIRMATION
By signing below, the student affirms they have read and met the eligibility requirements on page one and that the application information is accurate and complete to the best of his/her knowledge, and that providing false or misleading information may result in revocation of any scholarship award. The applicant also affirms that neither they nor a member of their immediate family are employed by JPMorgan Chase Bank, N.A. or affiliates. Immediate family member is defined as spouse, domestic partner, child (natural, adopted or step), parent or step-parent, sibling (natural, half, adopted or step) father- or mother-in-law, grandparent, niece, nephew or spouse/domestic partner of a child, parent, sibling, grandparent, niece or nephew. Student Signature*

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Date*

MonthDayYear
Date

Scholarship Application

William S. & Lillian R. Coleman and Ora T. & Dessie H. Lower Scholarship Funds
SECTION I - PERSONAL INFORMATION
Applicant's Name*

First NameLast Name
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home/Cell Phone*
Please enter a valid phone number.
Email Address*
example@example.com
Name and Location of School You Plan to Attend*
Date of Acceptance for Admission

MonthDayYear
Date
Name of High School*
Intended Enrollment

Full TimePart-time
I will be a

FreshmanSophomoreJuniorSenior
My GPA*

WORK EXPERIENCE

	MONTH/YEAR	JOB DESCRIPTION	HOURS PER WEEK	HOURLY WAGE
1.
2.
3.
4.
5.

Please list your major high school extracurricular, community activities, and honors or scholastic awards.

	NAME OF ACTIVITY	9th	10th	11th	12th	OFFICES AND HONORS
1.
2.
3.
4.
5.

Please list your major college extracurricular, community activities, and honors or scholastic awards.

	NAME OF ACTIVITY	Year 1	Year 2	Year 3	Year 4	Year 5	OFFICE AND HONORS
1.
2.
3.
4.

Describe your vocational goal. How will your educational plan aid you in achieving this goal?

SECTION II - PARENTS CONFIDENTIAL STATEMENT

This section should be completed by the applicant's parent or guardian. Please answer each question.

Father/Guardian's Information


Name
Age
Home Address
Occupation and Title
Employer
Years with Firm

Mother/Guardian's Information


Name
Age
Home Address
Occupation and Title
Employer
Years with Firm

	ANNUAL INCOME
1a. Father/Guardian Salary (before taxes)
1b. Mother/Guardian Salary (before taxes)
2a. Father/Guardian Other Income Source
2b. Mother/Guardian Other Income Source

Total Annual Income

PARENTS ASSETS - Farmers MUST complete Schedule C. Self-employed individuals MUST complete Schedule B.

	Amount	Description
Bank Accounts
Automobile
Automobile
Real Estate
Other Asset 1
Other Asset 2
Other Asset 3
Other Asset 4
Other Asset 5

TOTAL ASSETS

PARENTS LIABILITIES - Farmers MUST complete Schedule C. Self-employed individuals MUST complete Schedule B.

	Amount	Description
Notes Payable/Charge Cards
Automobile Loan
Automobile Loan
Real Estate Mortgage
Other Debt 1
Other Debt 2
Other Debt 3
Other Debt 4

TOTAL LIABILITIES
NETWORTH (ASSETS-LIABILITIES)
DEPENDENT CHILDREN - Enter the number of children you are currently claiming as dependents for Federal income taxes.

Please provide name of dependents who are attending college or other advanced school.

	NAME	AGE	PRESENT SCHOOL	YEAR IN SCHOOL
Dependent #1
Dependent #2
Dependent #3

SECTION III - EDUCATIONAL EXPENSES & FINANCIAL RESOURCES

Projected Expenses for Academic Year

	Projected Expenses
Tuition
Housing - Campus Students OR Transportation - Commuting Students
Books

TOTAL PROJECTED EXPENSES

Projected Resources

	Projected Resources
Student Savings/Work
Parents
Social Security/Veterans Benefits
Scholarships/Grants/Awards
Student Loans

TOTAL PROJECTED RESOURCES
FUNDING GAP (Expenses - Resources)

Please describe any scholarships, grants, loans or awards you have previously received or are currently applying for:

	Source	Amount	Date Applied	Date Received
1.
2.
3.
4.
5.
6.

SECTION IV - SPECIAL CIRCUMSTANCES AND CERTIFICATION
Please describe any physical handicaps:
Indicate any special circumstances that the Scholarship Committee should take into consideration.
PARENT AND STUDENT CERTIFICATION
STUDENT SIGNATURE - In the event I am granted this scholarship, I hereby certify that: 1. I will use the proceeds of the scholarship for the payment of required fees, board and room and similar living expenses, for institutional equipment, materials, and books. 2. The information submitted herewith is true and correct and I fully understand my obligations incurred by the scholarship application.*

Clear
Date*

MonthDayYear
Date
STATEMENT OF PARENT OR GUARDIAN - I, the undersigned parent, legal guardian, or person having custody of the student completing this application hereby agree to hold harmless the William S. Coleman and Lillian R. Coleman, Ora T. and Dessie H. Lower Memorial Scholarship Fund, its Trustee and Scholarship Committee from any liability or financial obligation beyond the amount which may be granted as a scholarship to the applicant. I certify the information provided herein to be true and correct to the best of my knowledge and belief. *

Clear
Date*

MonthDayYear
Date
By signing above, the student affirms that this information is accurate & complete to the best of his/her knowledge, and that providing false or misleading information may result in revocation of any scholarship award. Further, by signing and submitting an application to a scholarship trust for which JPMorgan Chase Bank, N.A., is trustee or agent, the applicant agrees that JPMorgan Chase Bank, N.A., may release any and all confidential information on this application to those individuals (previously identified on this application) whom JPMorgan Chase Bank, N.A., reasonably believes are the parent and/or guardian of said applicant, unless the applicant specifically notifies JPMorgan Chase Bank, N.A., in writing that such individuals may not have access to confidential information. In addition, by signing and submitting an application to a scholarship trust for which JPMorgan Chase Bank, N.A., is a trustee or administrative agent, the applicant hereby agrees that JPMorgan Chase Bank, N.A., shall have access to the applicant's confidential information in the possession of the postsecondary school at which applicant is expected to enroll (or actually enrolled) in order to verify proof of enrollment, grades, or any other information relevant to this application.

SUPPLEMENT "B" TO APPLICATION TO

WILLIAM S. AND LILLIAN R. COLEMAN AND ORA T. AND DESSIE H. LOWER MEMORIAL SCHOLARSHIP FUNDS
To be completed by owners of businesses:

Student Applicant First NameStudent Applicant Last Name
Parent Social Security Number:
Business Name:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Product or Service:
Type of Business

PartnershipCorporationSole Proprietor% Ownership

BUSINESS STATEMENT - ASSETS

	Amount
Bank Accounts
Inventory
Notes & Accounts Receivable
Equipment
Land & Building
Other Asset
Other Asset
Other Asset

TOTAL ASSETS

BUSINESS STATEMENT - LIABILITIES

	Amount
Accounts & Notes Payable
Real Estate Mortgages
Other Debt
Other Debt
Other Debt
Other Debt

TOTAL LIABILITIES
TOTAL NETWORTH

OPERATING STATEMENT

	YEAR 1	YEAR 2	YEAR 3
YEAR
I. TOTAL SALES
II. EXPENSES 1) wages paid to family members
2) other wages
3) rent
4) other expenses

III. YEAR 1 - OPERATING INCOME
III. YEAR 2 - OPERATING INCOME
III. YEAR 3 - OPERATING INCOME

	YEAR 1	YEAR 2	YEAR 3
IV. DEPRECIATION

V. YEAR 1 - NET INCOME FROM BUSINESS
V. YEAR 2 - NET INCOME FROM BUSINESS
V. YEAR 3 - NET INCOME FROM BUSINESS
Date

MonthDayYear
Date
Signature of Parent/Guardian 1

Clear
Signature of Parent/Guardian 2

Clear

SUPPLEMENT "C" TO APPLICATION TO

WILLIAM S. AND LILLIAN R. COLEMAN AND ORA T. AND DESSIE H. LOWER MEMORIAL SCHOLARSHIP FUNDS
To be completed by farm owners, operators, or tenants:

Student Applicant First NameStudent Applicant Last Name
Parent Social Security Number
I. LOCATION AND DESCRIPTION OF FARM:
A. Located in the Township of blanks in the county of blank in the state of on (address) miles from the nearest city or town which is .
B. Total acres owned blanks Present market value per acre $ blank.

C. Number of acres:

	Owned	Rented from Others	Rented to Others
1) Tillable
2) Nontillable
3) Pasture
4) Woodland & Waste
TOTAL

D. Number of Acres in:

	Truck Crops	Productive Orchard	Irrigation
Acres

E. Principal Products: blanks blank
F. Your farm business is a:

PartnershipCorporation% of your ownership
II. FARM VALUE - INVENTORY OF FARM ASSETS AS OF (DATE)blanks .

	Number	Present Market Value
A. Land and Buildings
B. Farm Machinery and Equipment
C. Beef Cattle
D. Dairy Cattle
E. Hogs
F. Sheep
G. Poultry (size of flock)
H. Grain (bushels)
I. Hay and Straw (bales)

J. Other Farm Products on Hand

	Farm Product Name	Number	Present Market Value
Farm Product
Farm Product

K. Other Farm Accounts

	Farm Account Name	Number	Present Value
Farm Account
Farm Account

Number Present Value

L. Accounts Receivable
M. Total Farm Value
III. FARM INDEBTEDNESS AS OF (DATE) blanks .

	Number	Present Value
L. Accounts Receivable

	Current Debt	Monthly Payments
A. Mortgages on Farm
B. Notes Payable to Banks
C. Notes Payable to PCA
D. Notes Payable to Individuals
E. Balances Owed on Farm Machinery and Equipment
F. Farm Charge Accounts Owed (feed, fertilizer, etc.)

G. Other Farm Debts (Specify)

	Farm Debt Type	Current Debt	Monthly Payments
Farm Debt
Farm Debt

H. TOTAL FARM INDEBTEDNESS *Include principal and interest in entries

IV. FARM INCOME

	YEAR 1	YEAR 2	YEAR 3
YEAR
A. Gross Farm Income
B. Operating and Fixed Costs
C. Depreciation

Year 1 Net Farm Income
Year 2 Net Farm Income
Year 3 Net Farm Income
Date

MonthDayYear
Date
Signature of Parent/Guardian 1

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Signature of Parent/Guardian 2

Clear
Should be Empty:

COLEMAN-LOWER SCHOLARSHIP

Scholarship Application

SECTION I - PERSONAL INFORMATION

SECTION II - PARENTS CONFIDENTIAL STATEMENT

SECTION III - EDUCATIONAL EXPENSES & FINANCIAL RESOURCES

SECTION IV - SPECIAL CIRCUMSTANCES AND CERTIFICATION

PARENT AND STUDENT CERTIFICATION

SUPPLEMENT "B" TO APPLICATION TO

SUPPLEMENT "C" TO APPLICATION TO

I. LOCATION AND DESCRIPTION OF FARM: