Harrisena Community Church
1616 Ridge Road, Queensbury, New York, 12804
Phone #792-1902 & FAX #743-0453

SCHOLARSHIP APPLICATION

(This application, in order to be considered, must be TYPEWRITTEN. The information provided will be kept strictly confidential.)

1.	Name:   _________________________________

1.	Mailing Address:____________________________________________________

1.	School you attend:                 _________________________________________________

1.	School you plan to attend this Fall: __________________________________________________                                         __________________________________________________________________

1.	Educational Goal: ___________________________________________________________________

1.	Summer and/or Part-Time Jobs: ____________________________________________________	                  __________________________________________________________________

1.	Father’s Name: _________________________________________________________________

1.	Mother’s Name: _________________________________________________________________

1.	List Brothers & Sisters (names, ages, schools): _______________________________________	             _____________________________________________________________________                                    _____________________________________________________________________
___________________________________________________________________________________	 ______________________________________________________________________________________

1.	High School Seniors are requested to have their Guidance Counselor forward to the Scholarship Committee an Official Transcript, exclusive of standardized and IQ Scores. The Transcript should include class rank in quarters. Transcript must be received by May 25th, 2018, by 4 PM.

1.	College Students should submit their latest Official Transcript or copy of grade reports. These must be received by May 25th, 2018, by 4 PM.

1.	Submit two current Letters of Recommendation from non-relatives. (Examples: Teachers, employers, neighbors, community leaders, etc.)

1.	ALL MATERIALS MUST BE RECEIVED BY THE Scholarship Committee by Friday, 
May 25th, at 4 PM.

HARRISENA COMMUNITY CHURCH - SCHOLARSHIP APPLICATION (page 2)

A.	Describe your personal interest in Harrisena Church:

B. 	Describe your involvement in the community:

C. 	How have your extra-curricular activities helped you grow and develop?

D. 	Describe your relationship with your family and discuss how you help at home:

HARRISENA COMMUNITY CHURCH - SCHOLARSHIP APPLICATION (page 3)

ESTIMATED BUDGET

Estimated Cost per Year:			Maximum Financial Aid Anticipated:

Tuition	_____________				Self-Contribution (Summer and/or Part-Time Jobs, etc.)

Room		_____________			________________________________________________

Board		_____________			________________________________________________

Books		_____________			________________________________________________

Fees		_____________			Contributions from Other Sources:

Other School-related Expenses:		_________________________________________________

____________________________			_________________________________________________

____________________________			_________________________________________________

TOTAL: 	______________		TOTAL: ____________________________

Estimated TOTAL DEFICIT: _________________
(Differences between Costs & Aid)

Please state any unusual financial circumstances in your family, such as medical expenses, unemployment, or anything that might affect your need for assistance:

Applicant’s Signature:  __________________________________________________

Date:			  _____________________________

ALL PARTS OF THIS APPLICATION MUST BE COMPLETED AND RECEIVED BY THE SCHOLARSHIP COMMITTEE BY FRIDAY, May 25th, at 4 PM.

	Mail To:	Scholarship Committee
			c/o Harrisena Community Church
			1616 Ridge Road
			Queensbury, NY 12804