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BPW DISTRICT 12

District 12 of the Pennsylvania Federation of Business and Professional Women's Clubs, Inc. gives out 3 scholarships each spring to provide financial assistance to individuals who demonstrate financial need and who seek additional education to advance careers or to re-enter the job market.

Interested applicants must complete the necessary forms as well as provide a detailed description of their career plans and how the desired schooling will help achieve these goals.
 
Deadline for applications was March 15, 2016.
Next year there will be contact information for the 2016 scholarship.

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BARBARA J. MYERS-CICCONE 
MEMORIAL SCHOLARSHIP

District 12 BPW Tribute to Women Scholarship Application

(Scholarship Application Deadline is March 9, 2017)

 

 

Please type or print

 

Personal Data:

 

Name:     _____________________________________________________________________

                                    (Last)                                    (First)                                    (Middle)

 

Permanent Address:    ___________________________________________________________

                                                                        (Number, Street and Box Number)

                                    ___________________________________________________________

                                                            (City)                                    (State)                                   (Zip)

 

Home Phone:  (____) ____________    U.S. Citizen:  Yes ___   No ___

 

Date of Birth: _____________            Age:   __________

 

Marital Status:  (  ) Single       (  ) Married       (  ) Separated       (  ) Divorced       (  ) Widowed

 

How many dependents will you have during the period covered by this scholarship application?  Number: ______      Ages:  _______________      Relationship:  _________________________

 

Are you a BPW Member?  Yes ___     No ___ 

If “yes,” Name of your Local Organization:           _____________________________________ 

Where did you learn or read about the scholarship?  ____________________________________

 

 

 

Educational Information: 

 

Name of School:  _________________________________________________________

           

Address:             _________________________________________________________                                          _________________________________________________________

 

Have you been accepted into the program for which you request funds?  Yes ___ No ___

 

Major:  ________________     Will you attend:     Part Time ______    Full Time ______

 

Specific Degree/Certificate you expect to receive: _______________________________

 

Date that course or term is scheduled to begin:       Month ________    Year ___________

 

When do you expect to complete this course of study?      Month ______ Year _________

 

                        


 

Educational Background:

Check highest educational level achieved:

 

_______     High School Graduate         _______    College/University Degree

_______     Completed GED                  _______    Some Business/Technical School

_______     Some College                      _______    Business/Technical Degree/Certificate

 

List in chronological order all schools or training courses you have attended since high school.  Start with most recent.  Include courses in which you are presently enrolled.  Insert extra pages if additional space is required.  Do not substitute resume.  You must attach an academic transcript of your most recent educational endeavor.

 

Month/Year

Name/Location of  Institution

Major

GPA

Degree

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Homemaking, Volunteer and Paid Employment:

List your work experience in chronological order, starting with most recent.  Insert extra page if additional space is required.  Do not substitute resume.

 

Dates

From/To

Position Title

Employer

& Location

Responsibilities

& Duties

Full Time/

Part Time

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Will you work while you continue your education?             Yes          _____       No           _____

                                                                                                Part Time _____      Full Time _____

 

Type of employment:  ___________________________________________________________

Other pertinent data (awards, etc.):  _________________________________________________

______________________________________________________________________________

______________________________________________________________________________


 

Financial Aid Request:

 

Applicant:  A Free Application for Federal Student Aid (FAFSA) for the coming academic year is required for this scholarship.  This form is available at the college financial aid office or high school guidance office or online at www.fafsa.ed.gov.  This form must be submitted by March 1 in order for the Financial Aid Office to access this information.

 

Please complete this release authorization and have the Financial Aid Officer at your school complete the following information:

 

 

Name _____________________________________  SS# _____________________________

                              (Please Print)

Address _____________________________________________________________________

 

My signature authorizes release of requested information to the BPW District 12 Scholarship Selection Committee.

 

Signed: ____________________________________       Date:  _________________________

 

 

Name and address of college or postsecondary institution where check should be mailed: 

__________________________________________________

(Contact Person)

__________________________________________________

(Institution)

__________________________________________________ 

                                                                 (Mailing Address)

 

Cost of Education Budget for academic year:          Financial Aid Awards for academic year:

 

Tuition/Fees                           __________                Pell Grant                      __________

Room/Board                           __________                PHEAA Grant                __________

Books, Supplies                      __________                FSEOG Grant                __________

Transportation                                    __________                Private Scholarships      __________

Miscellaneous                        __________                Stafford Loan                __________

Other __________         __________

TOTAL COSTS                      __________                TOTAL AID                  __________                                                                           

Estimated Family Contribution _________                    Cumulative G.P.A.        __________

 

      Is the student in good academic standing?                      Yes _____     No _____

 

      Is your school an accredited educational institution?       Yes _____     No _____

 

Certification and Acknowledgement:  I hereby certify that the information contained herein is true and correct and a full disclosure of the financial aid package attributable to the herein named student.  

 

____________________________    ___________________________      ________

       Financial Aid Officer                                                               Title                                             Date


 

Career Objectives:

 

Please attach a one-page essay describing your short term career goals and, specifically, how this proposed training will help you to accomplish these goals.  Please explain how these apply to your long range career goals. Include a summary regarding the following topics:  self, educational goals, issues which are important to working women in today’s world.

 

References:

 

Two reference letters are required for your application to be complete.  Please provide the names and addresses for your references below.  We recommend that one reference be from an employer or teacher.  Letters of recommendation must be no more than one year old at the time of application.  Applicants are responsible for ensuring that letters of recommendation are received by the deadline date.

 

Name:  _____________________________________________

Street Address:            _________________________________

City, State, Zip:          _________________________________

 

 

Name:  _____________________________________________

Street Address:            _________________________________

City, State, Zip:          _________________________________

 

 

Certification:

 

I certify that to the best of my knowledge the information contained in this application is true and correct.  I understand this application will not be considered for review unless it includes the following:

 

1)     a copy of my most recent academic transcript

2)     the financial aid section has been completed by a financial aid officer at my school

3)     a one-page essay describing my career objectives

4)     two letters of recommendation (which may be mailed under separate cover)

5)   a complete, signed and dated application form

 

I am aware that no materials will be returned.  If I am selected as a scholarship recipient, I hereby give permission for my name and school to be announced in local newspapers without further notice or consent from me.

 

_____________________________________                      _______________

                    Signature                                                                               Date

 

 

 

 

Complete application packets should be mailed to 

Denice Robinson 80 Oakland Avenue, Uniontown, PA 15401

, prior to March 9, 2017.

OR COPY AND PASTE THE APPLICATION BELOW INTO A WORD DOCUMENT.

Click on the words below for a copy of the application that can be printed


SCHOLARSHIP APPLICATION