assist indigent
The purpose of this scholarship is to aid/assist indigent students of Atlantic City High School, who reside in Atlantic City, to continue their education past high school (Ex: 2 year college, 4 year college, Vocational School, Business School). The criteria used to identify eligible candidates are: (1) Students suffering sickness, unusual circumstances or other misfortunes. (2) Students eligible for free or reduced lunch. A copy of your transcript, SIS Express printout showing free or reduced lunch, two (2) letters of recommendation, and verification of income (tax return, payroll stub) must accompany the application. Recipients will be able to reapply each year for renewal of their scholarship until they have completed their education. Renewal Applicants: In order to renew the scholarship, recipients much show current proof of Atlantic City residency, a current transcript showing satisfactory grades, two letters of recommendation (at least one from a college representative), and verification of income (tax return, payroll stub).
Please return completed application to Atlantic City High School Guidance Department on or before April 13, 2018. 1400 N. Albany Avenue Atlantic City, NJ 08401 [email protected]
Name ________________________________________________________________________ Last
First
Middle
Address ______________________________________________________________________ Street
______________________________________________________________________________ City
State
Zip Code
Telephone #____________________________________________________________________ Home
Cell
Email address __________________________________________________________________ D.O.B. _____________ Age _________ Sex ______ Social Security # _ XXX-XX-___
_____
Place of Birth _______________________________Year of Graduation from ACHS_________
BACKGROUND INFORMATION Mother’s Name ________________________________________________________________ Address ______________________________________________________________________ Name & Address of Employer _____________________________________________________ Position ________________________ How Long? __________ Yearly Income _____________ Father’s Name _________________________________________________________________ Address ______________________________________________________________________ Name & Address of Employer ____________________________________________________ Position _______________________ How Long? __________ Yearly Income ______________ Number of Siblings ____________ Sisters ________ Brothers _______
Applicant’s Employment Record Employer 1. 2. 3.
Position
Date
Salary
What course of study/profession/vocation do you plan to pursue? ______________________________________________________________________________ ______________________________________________________________________________
To what school(s) have you been accepted?
Approximate Tuition
______________________________________________________
____________________
______________________________________________________
____________________
______________________________________________________
____________________
In what extra-curricular and community activities have you been involved? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
List all honors and awards that you have received in school and the community. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
ESSAY In typed, essay format, tell anything about yourself that will assist the Selection Committee in choosing you as the recipient of the Frank & Lillian Poucher Scholarship. (250-300 words)
___________________________________________________ Applicant’s Signature
____________________ Date
___________________________________________________ Parent’s Signature
____________________ Date
Please return completed application to Atlantic City High School Guidance Department on or before April 13, 2018. 1400 N. Albany Avenue Atlantic City, NJ 08401 [email protected]
Name ________________________________________________________________________ Last
First
Middle
Address ______________________________________________________________________ Street
______________________________________________________________________________ City
State
Zip Code
Telephone #____________________________________________________________________ Home
Cell
Email address __________________________________________________________________ D.O.B. _____________ Age _________ Sex ______ Social Security # _ XXX-XX-___
_____
Place of Birth _______________________________Year of Graduation from ACHS_________
BACKGROUND INFORMATION Mother’s Name ________________________________________________________________ Address ______________________________________________________________________ Name & Address of Employer _____________________________________________________ Position ________________________ How Long? __________ Yearly Income _____________ Father’s Name _________________________________________________________________ Address ______________________________________________________________________ Name & Address of Employer ____________________________________________________ Position _______________________ How Long? __________ Yearly Income ______________ Number of Siblings ____________ Sisters ________ Brothers _______
Applicant’s Employment Record Employer 1. 2. 3.
Position
Date
Salary
What course of study/profession/vocation do you plan to pursue? ______________________________________________________________________________ ______________________________________________________________________________
To what school(s) have you been accepted?
Approximate Tuition
______________________________________________________
____________________
______________________________________________________
____________________
______________________________________________________
____________________
In what extra-curricular and community activities have you been involved? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
List all honors and awards that you have received in school and the community. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
ESSAY In typed, essay format, tell anything about yourself that will assist the Selection Committee in choosing you as the recipient of the Frank & Lillian Poucher Scholarship. (250-300 words)
___________________________________________________ Applicant’s Signature
____________________ Date
___________________________________________________ Parent’s Signature
____________________ Date
