2025 CSF Scholarship Application Form

CLARK SCHOLARSHIP FUND Application Form

Application Deadline - April 4, 2025
The Clark Scholarship Fund is a community project that provides scholarships for graduating high school seniors who have lived in Clark, NJ for at least one year prior to April 1st and who need financial help to continue their education

Read and follow the instructions carefully prior to submitting your application. All winners will be notified on or before the 31st of May 2025.

Documents required:
1. This application, completed through this form.
2. Three (3) Letters of Reference - to be provided by the Guidance Department.
3. A 300-word essay discussing the reasons for choosing the field of study listed in the application - to be included within this form below.
4. High school transcripts and records - to be provided by the Guidance Department.
APPLICATIONS RECEIVED AFTER THE DEADLINE WILL NOT BE ACCPETED.

Requirements:

The Scholarships are awarded based primarily on financial need, taking into account academic achievement, character and leadership as demonstrated by school and community activities and the letters of recommendation.

The award is made to the student but paid directly to the student's school in payments as each scholarship so directs. The student should inform the Fund in writing as to the school to which the payments are to be made. If the student should change schools, then it is the student's responsibility to so notify the Clark Scholarship Fund in writing.

The student is obligated to let the Fund know of all other awards. If the student's awards exceed the cost of the annual tuition and college costs, then the scholarship will not be granted. Loans and/or employment earnings do not disqualify the scholarship award.

The awards from the Clark Scholarship Fund will be voided for any of the following reasons:
- The student does not matriculate.
- The student does not maintain passing grades or drops out of school.
- If the student's conduct at any time is against decorum, law, and order.
- The student fails to salute the United State Flag where customs so require.
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.
I. Personal Data

Tell us about yourself
Full Name of Applicant*

First NameLast Name
Birthdate*

MonthDayYear
Mobile No*
Personal Email (not your school Email)*
Where the confirmation will be sent to
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of years you have lived in Clark*
High School Attended*
GPA*
Weighted Average GPA
Please provide at least your verbal and math SAT scores OR your composite ACT score below.
Which scores will you be submitting?*

SATACTBoth
SAT Score - Verbal*
SAT Score - Math*
Composite ACT Score*
Names of schools to which you have applied, in order of preference:*
Please select the 2023-2024 school year academic scholarships for which you are applying to.*

Henry C. Staeger Scholarship: $4,000 payable at $1,000 each of 4 yrs.Charles E. Driesens, Jr. Engineering Science Scholarship: $4,000 payable at $1,000 each of 4 yrs.William Sanguiliano Scholarship: $3,000 payable at $750 each of 4 yrs.Dr. Alex P. Kowalenko Osteopathic Scholarship: $3,000 payable at $750 each of 4 yrs.2025 Clark Jaycees Scholarship: $1300 payable at $650 for 2 yrs.

II. Scholarship Release Form

To be completed by a parent or guardian.
I give my permission for the release of my son/daughter's transcript and high school record to the scholarship programs explained in the 2024-2025 scholarship booklet.
Signature*

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III. Family Financial Information
As financial need is emphasized in the award of Clark Scholarships, this statement MUST be filled out completely by parents or guardian for students to be eligible for scholarship.
A. Father, or Guardian
Living?*

YesNo
Divorced from your mother?*

YesNo
Father’s Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Employed?*

YesNo
Occupation*
Employer*
Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
B. Mother, or Guardian
Living?*

YesNo
Divorced from your father?*

YesNo
Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Employed?*

YesNo
Occupation*
Employer*
Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
C. List of Dependents

Please provide a list of dependents (other than Applicant and Parents) supported by Family Income. This includes siblings, even those in college.
Are there any dependents (other than Applicant and Parents) that are supported by Family Income?*

YesNo
Please provide the following information regarding the dependent:
D. Family Income - Tax Year 2024
Every field must be filled in. Put "0" (zero) in fields that have no value. Unless a parent is listed as deceased (above), income from both parents should be listed. If a parent has zero income, please offer explanation below. If you are completing this form prior to filing your tax return, please provide your best estimate.
Father's Gross Annual Salary, as report on Form 1040*
Mother's Gross Annual Salary, as report on Form 1040*
Amount added to family income by other residents living at home (if any)*
Total income from Social Security, Pension, Retirement (if any)*
Income from Disability (if any)*
Total income from Investments and Annuities*
Total income from Alimony (if any)*
Income from Child Support conveyed to divorced spouse for children*
Income from Inheritance (if any)*
Other family incomes (ex. Government support, Unemployment)*
TOTAL FAMILY INCOME - FY24*
If a parent has zero income sources listed above, please explain:
E. Family Income - Tax Year 2023
Every field must be filled in. Put "0" (zero) in fields that have no value. Unless a parent is listed as deceased (above), income from both parents should be listed. If a parent has zero income, please offer explanation below.
Father's Gross Annual Salary, as report on Form 1040*
Mother's Gross Annual Salary, as report on Form 1040*
Amount added to family income by other residents living at home (if any)*
Total income from Social Security, Pension, Retirement (if any)*
Income from Disability (if any)*
Total income from Investments and Annuities*
Total income from Alimony (if any)*
Income from Child Support conveyed to divorced spouse for children*
Income from Inheritance (if any)*
Other family incomes (ex. Government support, Unemployment)*
TOTAL FAMILY INCOME - FY23*
If a parent has zero income sources listed above, please explain:
F. Family Liabilities
Every field must be completed. Put "0" (zero) in fields with no value.
Annual mortgage/rent*
Annual real estate taxes*
TOTAL REAL ESTATE EXPENSES*
Home equity loan debt*
Credit card loan debt*
Pension or 401K loan debt*
Annual expense for children in college, other than applicant:*
Annual expense for children in private schools:*
TOTAL OTHER LIABILITIES*
TOTAL ANNUAL FAMILY LIABILITIES*
G. Military / Government Benefits
Is anyone in your household receiving benefits under the Jr. G.I. Bill?*

YesNo
If so, how much?*
Is anyone in your household eligible for or drawing Social Security payments that were not already listed in Section D above?*

YesNo
If so, how much?*
H. School Selection

Though you may not have committed to attending a particular school yet, please list your first choice or the school you are most likely to attend.
First choice school*
I. Sources of Scholarships, Grants, and Financial Aid

Please let us know which grants, loans and scholarships you have applied for or already received. If none, please type “None” and “0”.
Scholarships, Grants, Financial Aid
Total Scholarships, Grants, and Financial Aid
J. Estimated Receipts
Give an estimate of your receipts for one year at your first choice college. Every field must be completed. Put "0" (zero) in fields with no value.
Amount from Student's Funds*
Amount from Parents*
Amount from Loans*
Amount from College Work-Study Program*
Funds from Social Security*
Scholarships, Grants, Financial Aid*
Amount from Other Relatives*
TOTAL ESTIMATED RECEIPTS*
K. Estimated Expenses
Give an estimate of your expenses for one year at your first choice college. Every field must be completed. Put "0" (zero) in fields with no value.
Tuition for first year*
Fees (Laboratory, etc.)*
Books, computer, supplies*
Will the applicant board at school or commute?

BoardCommute
Room and Board*
Car Costs*
Commuting Costs (parking, air, tolls)*
Meal Plan*
Medical, Health, Dental, Vision*
Clothing/Laundry*
Other Expenses (Please List)
TOTAL ESTIMATED EXPENSES*
L. Estimated Need
Your need is calculated as your Estimated Expenses less your Estimated Receipts. Based on the information provided above, your estimated need is:*
Please share any special circumstances the board of the Clark Scholarship Fund should consider which may be vital to this application. Feel free to comment on employment challenges, continuing medical bills or any other unusual circumstances that may not have been fully reflected in earlier sections:
IV. College & Career Goals

Please answer the below questions and feel free to attach any additional sheets as necessary.
Major Area of Study*
Please indicate what is your major are of study
Essay topics - please choose one topic:
1. Write a 300-word essay discussing your reasons for choosing the field of study listed above. Some students have a relationship, personal experience, background, identity, interest, or talent that is so meaningful that is has inspired them to pursue a particular field of study. Please help the Board of the Clark Scholarship Fund understand you as a person by sharing your story of inspiration.
2. Share an essay of any length (300 words or greater), on any topic of your choice. It can be one you've already written and submitted elsewhere. This essay should help the Board of the Clark Scholarship Fund understand you as a person.
Essay*

0/1000
What is your career goal?*
List your extra-curricular activities during your high school years: sports, offices held, clubs, honors and awards, volunteer work in school and community. You may instead attach a resume or profile of student reported activities.*
Resume/Profile of Student Reported Activities

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List your paid work experience during your high school years, including summers, if applicable. You may attach a resume above.

V. Letters of Reference
Since the members of various scholarship committees are not familiar with the applicants they evaluate, it will be helpful to them to consider the information of others can provide regarding your character and ability. Please submit three (3) Letters of Reference with this application to be eligible for a scholarship.
1. Guidance Counselor
2. Teacher, community member other than a relative, certifiying to the application's character and leadership.
3. If you are applying to a program awarded for a particular achievement (e.g. music, theatre, athletics), please submit a letter form a person who has coached you in this area.
Letter of Reference #1*

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Letter of Reference #2*

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Letter of Reference #3*

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VI. Applicant's E-Signature
By signing the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
Signature*

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CLARK SCHOLARSHIP FUND Application Form

I. Personal Data

II. Scholarship Release Form

III. Family Financial Information

A. Father, or Guardian

B. Mother, or Guardian

C. List of Dependents

D. Family Income - Tax Year 2024

E. Family Income - Tax Year 2023

F. Family Liabilities

G. Military / Government Benefits

H. School Selection

I. Sources of Scholarships, Grants, and Financial Aid

J. Estimated Receipts

K. Estimated Expenses

L. Estimated Need

IV. College & Career Goals

V. Letters of Reference

VI. Applicant's E-Signature