FSA Scholarship Application Form Due Date February 17, 2021 (Albertsons Tom Thumb)

2021 FSA SCHOLARSHIP FOUNDATION - Scholarship Program

Application Deadline - Tuesday, February 17, 2021
Your e-mail address is very important and is our link to you. Applicants will receive an e-mail from FSA as proof of receipt of your application, for your interview date, and if you are a winner. Make sure your e-mail address is legible, active, and that you check it frequently.
I. Personal Data
Full Name *

Prefix First Name Middle Name Last Name Suffix
Social Security Number :
(e.g. 123456789)
Birthdate: *

Month Day Year
Mobile No. : *

Area Code Phone Number
Alternate Phone #

Area Code Phone Number
E-mail : *
Where the confirmation will be send to
Home Address : *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
II In Case of Emergency, whom should we contact?
Full Name *

Prefix First Name Middle Name Last Name Suffix
Phone Number *

Area Code Phone Number
Optional Informations :

Information regarding gender, ethnic origin and race are optional. The information is requested for post-scholarship report generation and is important to FSA and its 501 (c) (3) status. It does not affects your selection for a FSA scholarship award.
Gender:

Male Female
Are you a US citizen?

Yes No
Race? (Choose one or more):

White Black or African American Asian American Indian or Alaskan Native Hawaiian or Other Pacific Islander Non-Resident Alien
III. Education Information:
What year will you or did you Graduate from High School or received your GED: *
Status at the time of application: *

I will graduate in May 2021 I will be an incoming freshman graduating high school prior to 2021 I have attended college but have less than 32 college credit hours I have attended college but have at least 32 or more college credit hours I am a GED graduate with no college credit hours
Most recent High School cumulative GPA: *
Name of High School
City/State
Name of College or University currently attending or plan to attend
Degree or Major Planned
Will you be pursuing WAFC Retail Certification Program? *
High School activities, community activities, volunteer work, honors, offices held:
IV. Plans and Goals
Describe your education goals and explain why you have decided to further your education at this time. *

0/300
How do you plan to pay for college?
Describe your PROFESSIONAL GOALS and tell us where you see yourself in 5 years. *
V. ACT or SAT Information
ACT or SAT Exam is not required, but helpful. Year you took the ACT or SAT?
Overall score?
Do you have a future test date? If so, when it is?
VI. For Students Currently Enrolled at a College or University
Approximate number of credit hours you have completed as of January 2021 *
Current GPA:
Estimated credit hours needed to complete your Undergraduate Degree
Estimated cost per semester (tuititon and books)
College or University activities, honors, offices held, etc.:
VII. Employment
What Retailer do you work for and store number? *
Describe your current position; including responsibilities, average weekly hours worked and number of employees you directly supervise: *

Click to edit *

Store Name and number

Position/Title or Duties

Start Date

End Date

Supervisor's Name

Phone Number

Your Current Job at:

Next Prior Position as:

VIII. Personal Household Information
Select One
Number of Children
STEP 1: Do you live with your parents? (If No, go to STEP 2)
Continue: Father's Occupation and Estimated Annual Income
Continue: Mother's Occupation and Estimated Annual Income
STEP 2: Do you own a home or rent, for how long?
Continue: Do you support yourself?
Continue: Number of people in your household?
Continue: Number of dependents you support including yourself?
Your Spouse's Occupation and Employer?
STEP 3 Estimated Annual Gross Household Income including your income?
Do you have unusual expenses? Do you have any unusual medical expenses? Do you have any unusual circumstances that we should be aware of? Explain any unusual circumstances below:
Are you currently receiving any other financial assistance toward your education? If so, please identify the source and value:
IX. Extras:
FSA Scholarship Foundation offers scholarships to individual with a sincere interest in the food retailing industry. We offer aid to students that represent this interest. Please check each of the qualifiers below that apply to you. This data helps us understand you. Please note, if you are awarded a scholarship based on any of these qualifiers, you will be asked to produce documentation verifying your unique eligibility.
Have you read all rules and qualifications for the FSA Scholarship on the website and understand them? *

Yes No
Have you receive an FSA Scholarship before? *

Yes No
If you have received an FSA Scholarship, what year did you receive the scholarship and did you collect all funds?
Do you reside in one of the FSA participating counties? *

Yes No
Are you interested and willing to major in fields related to the Retail Grocery Induatry? *

Yes No
Do you intend to continue to work at your grocery store while attending college? *

Yes No
If so, will you work:

Full-time Part-time
X. Essay
Your essay should be 500 words. You should address in your essay: why you want to pursue a career in the food sales industry, your college goals and choice of major, what you intend to do with your education, and why a scholarship is important to you. Include any academic and non-academic accomplishments, personal characteristics, or experiences that make you uniquely worthy of scholarship consideration.
Essay: *

0/550
XI Up Load Documents
First Personal Reference Letter *
Second Personal Reference Letter *
High School Diploma or GED is required if you have already graduated from High School
ACT or SAT Scores are not necessary, but are helpful
If Attending High School now, HS Transcripts are required
Store Manager's Comments Sheet (SMCS)

Browse Files

Cancel of
If attending or have attended College Transcripts are required
X. Applicant's E-Signature
By signing (typing your legal name) in 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. DEADLINE FEBRUARY 17, 2021
E-Signature: *
The FSA Scholarship Foundation is committed to equal opportunity in employment and education. The College does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
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2021 FSA SCHOLARSHIP FOUNDATION - Scholarship Program

I. Personal Data

II In Case of Emergency, whom should we contact?

III. Education Information:

IV. Plans and Goals

V. ACT or SAT Information

VI. For Students Currently Enrolled at a College or University

VII. Employment

VIII. Personal Household Information

IX. Extras:

X. Essay

XI Up Load Documents

X. Applicant's E-Signature