Scholarship Application

District 23 Senatorial Scholarship Questionnaire

Applications must be postmarked by May 1st, 2015 to be considered on-time.

(Late applications will only be considered if there are additional funds once the initial awards have been made.)

Please complete this questionnaire. You may save data typed into this form. Mail completed questionnaire and an unofficial transcript of your grades to:

Senator Douglas J.J. Peters
James Senate Office Building
11 Bladen Street, Room 121
Annapolis, Maryland 21401

Applications will not be accepted via fax

Please note that in order to qualify for a senatorial scholarship you must have filed a free application for federal student aid (FAFSA) and live within the 23rd legislative district. Before applying please visit www.mdelect.net and enter your permanent home address to view your legislators, this will ensure you are applying to the correct office

(For more information please carefully read the scholarship information letter)

General Information

Name:

Address:

(Please use your permanent home address, not a school address)

Email:

(We will use this address to confirm application receipt – please be sure we can read it)

Home Phone: Cell:

Date of Birth: Sex: Male Female

Last 4 digits only of your social security number

(We use this information to identify you in the Higher Education Commission’s data base)

Status: (Please circle) Single Dependant Married Divorced

Single Independent (If under age 24, parents must be Maryland residents)

This must be the same status as is indicated on your FAFSA

Mother/Guardian’s full name

Father/Guardian’s full name

School Information

Current High School (if applicable):

Overall High School GPA: SAT Scores: Verbal Writing Math

Are you attending College/Trade School now? Yes No

Year in school

Overall Undergraduate/Graduate GPA: Total Credits Earned:

My transcript is attached My transcript will be mailed directly from the school

Name of College/Trade School and location currently attending (if applicable):

(I.e., University of Maryland, Baltimore County or Prince George’s Community College, Largo campus)

Name of school/location you plan to attend/apply to in 2015-2016. Also please note if you have been accepted or are waiting for acceptance.

(Please remember you must be attending a Maryland Institution, or have been approved for unique major status if attending an out of state institution in order to qualify for a scholarship. For more information please carefully read the scholarship information letter)

Will you attend college/trade school full time or part time?

# of Credit Hours

What degree and major are you/will you pursue?

Briefly summarize your objective in attending college/trade school:

Extracurricular and Community Service

Please list clubs, sports, interests, activities and community involvement:

List any academic honors and/or leadership positions held:

Financial Information

This section MUST be completed – incomplete applications will not be processed

(Please use amounts listed on the FAFSA to answer the financial questions – these responses must match those given on the FAFSA)

Are you currently employed? Yes No Full time: Part time: Income:

Name of Employer:

Do you intend to work during the upcoming college year? # of Hours/Week

Total Household Income:

If applicable:

Spouse’s Occupation: Annual Income

If dependent:

Mother/ Guardian’s Occupation: Annual Income

Father/Guardian’s Occupation Annual Income

List other financial aid that you have you applied for, its duration and if it has been awarded:

Please list other members of your household by name, age and relationship that are dependent on the same household income as you. Also, please indicate if they are currently in school and what school they attend.

Please describe any special circumstances which create a need for financial assistance:

If you need more room to answer, please attach additional pages.

Please note that failure to provide all necessary information with your application will result in a delay and possible disqualification.

Please Remember To Attach Your Unofficial Transcript.

If your transcript is being forwarded directly from your school, please note that here.

Questions? Please call our office at 301-858-3631

Please keep a copy of the entire application for your records.