Service Opportunities

Application for Thomas B. Dixson Family Memorial Scholarship

 

Applicant's Name:   
 		  
First: Middle: Last:  
Address:        
City: State: Zip Code:  
Date of Birth:  
Place of Birth:
 		  
Social Security #:    

 

Father's Name: 
First: Middle: Last:  
Address:      
 
City: State: Zip Code:  

Occupation:   Employer:
 

 

Mother's Name: 
First: Middle: Last:  
Address:    
 		  
 		  
 
City: State: Zip Code:  

Occupation:   Employer: 
 

 

Are you dependent upon your parents for your support? 
                               		 
 
Total Number of Dependents your Parents Support:  

Give their relationships and ages (relationship, age):
 

What is the approximate amount they will be able to contribute annually

toward your college expenses?   

 

Are you married?
                           		 
 
 
Spouse's Name:      
First: Middle: Last:  
Address:    
 		  
 		  
 
City: State: Zip Code:  

Occupation:   Employer:
 

 

Do you have any children?
                          		Ages:  
Do you have any other dependents?
                          		 
 
Give their relationships and ages (relationship, age): 

 

 

High School: 
 		 Date of Graduation: 
 
Address:
 		    
City: State: Zip Code:  
Please send your transcript of high school grades to jhuggins@berry.edu
(unless you are currently attending college)
 
 

  

Profession studying for:    
 
College or University attending:  
Have you applied for admission?
                  		Have you been accepted?
                 
Major course of study:    
 
When you will complete this course of study:   
Please send your transcript of your grades to date to jhuggins@berry.edu  

Briefly describe any activities in which you have participated which you feel would be of interest to the Committee. You may include home, school, church, or community projects. Also include information relevant to your needs for financial aid in order to continue your education.  Briefly describe your goals in life and plans for attaining these goals.

 

List below your proposed annual budget for attending college during the upcoming academic year:

 

Expenses:
  
Income:  
 
Tuition and Fees $   Personal Savings $  
Books and Materials $  Earnings during vacation $ 
Room and Board $  Part-time earnings Academic Year $ 
Clothing $  Aid from parents $ 
Lunches and Travel Expenses $  Aid from relatives $ 
Organized Dues and Assessments $  Scholarships or Grants $ 
Personal and Recreational $  Veterans/Social Security Benefits $ 
Other (explain below) $  Spouse's Income $ 
 
 		 Other (explain below) $ 
Total:  $   
 
    Total:  $ 

 

 

Place form elements here...

 

 

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