JIM WEBB SCHOLARSHIP APPLICATION

APPLICANT INFORMATION

Student's Name

First

Middle

Last

Email

Phone

Parent/Guardian Name

First

Last

Parent/Guardian Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Are you currently enrolled at Russellville High School?

Yes
No

College, University, or other educational institute student plans to attend. (Indicate name and location of school)

First Choice

College, University, or other educational institute student plans to attend. (Indicate name and location of school)

Second Choice

College, University, or other educational institute student plans to attend. (Indicate name and location of school)

Third Choice

Student's Signature:

Parent's Signature:

OBJECTIVE CRITERIA LIST

ACT Composite Score:

Numeric Cumulative GPA:

Weighted GPA:

Unweighted GPA:

Upload the student's transcripts for Freshman, Sophomore, Junior, and Senior years.

Drag & Drop Files, Choose Files to Upload You can upload up to 4 files.

Please list any advanced or honor courses below:

FINANCIAL NEED

Please complete the information requested below for financial need determination. (This information is considered completely confidential)

Number of dependents in household on last year's income tax return:

Gross family income as filed on last year's income tax return:

List the total number of dependents who will be attending college (including yourself) during the fall semester of the upcoming year:

Please list the highest level of education completed by your parents/guardian:

Please provide any additional information or explanation to clarify any circumstances which will affect your financial ability to attend college during the upcoming year:

Have you completed the FAFSA?

Yes
No

Will you be receiving financial aid from FAFSA?

Yes
No

Please list any scholarships you have already accepted/received:

HIGH SCHOOL EXTRACURRICULAR ACTIVITIES

Grades 9-12

Did you graduate from the Franklin County Junior Leadership Program?

Yes
No

Organizations and Clubs (indicate years of involvement and any offices held):

Honors and Awards:

Athletics and Band:

Community Involvement (be specific):

WORK ACTIVITES

List all types of employment you have had during the past twelve months. Indicate the type of work, your employer’s name, and the number of hours worked per week.

Place of Employment 1

Type of Work 1

Hours 1

Place of Employment 2

Type of Work 2

Hours 2

Place of Employment 3

Type of Work 3

Hours 3

Place of Employment 4

Type of Work 4

Hours 4

PERSONAL ESSAY

Please describe, in 100 words or less, why you want to be a recipient of this scholarship, the course of study you plan to follow, and your proposed occupation.

Paragraph Text

LETTERS OF RECOMMENDATION

Your application must include two letters of recommendation. One from a teacher in your high school and one from a member of your community other than a relative.

Recommendation 1 – From a teacher in your high school

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*NOT a relative

Recommendation 2 – From a member of your community*

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*NOT a relative

SCHOLARSHIP RESUME

Your application must include a one page scholarship resume.

Scholarship Resume

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Agreement

I agree

By checking this box, I am agreeing that all of the information provided in this application is true to the best of my knowledge, and that I am the author of this essay.
I agree and acknowledge that the Scholarship Committee’s decisions are final and without prejudice.

Student's Signature

103 North Jackson Avenue

256-332-1760

Mon - Fri
9:00 AM -4:30 PM

103 North Jackson Avenue

256-332-1760

Mon - Fri
9:00 AM -4:30 PM

APPLICANT INFORMATION

OBJECTIVE CRITERIA LIST

FINANCIAL NEED

HIGH SCHOOL EXTRACURRICULAR ACTIVITIES

WORK ACTIVITES

PERSONAL ESSAY

LETTERS OF RECOMMENDATION

SCHOLARSHIP RESUME

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