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2022 MAYNARD JENSEN AMERICAN LEGION

MEMORIAL SCHOLARSHIP PROGRAM

GUIDELINES

1. Applicants must be sons or daughters, grandchildren or great-grandchildren, adopted

or stepchildren of members of Department of Nebraska, The American Legion or

POW, MIA, KIA, or any veteran that was a current Legion member at time of death.

2. Applicants must be a high school graduate or be earning sufficient credits to graduate

from high school at the conclusion of the spring 2022 semester, or be enrolled full

time in a Nebraska post-secondary institution as of March 1, 2022, application

deadline date.

3. Applicants must be enrolled or in the process of being enrolled full time in an

accredited NEBRASKA institution of higher education to include university, college, or

technical school, public or private.

4. Selection of recipients will be made based on the following:

a. ALL questions answered or N/A indicated.

b. Financial need.

c. Academic achievement.

d. Extracurricular activities.

5. Department of Nebraska American Legion Scholarship Committee will evaluate

applications and select recipients.

6. Scholarships must be used at the beginning of the academic year immediately

following notification of awards. Use cannot be delayed nor can awards be held for

future use or transferred to other individuals. Scholarship must be used at school

indicated on application.

7. Scholarship stipends will be sent to the institution of the recipient's attendance to be

held for use in their name for tuition and fees, books, room and board only. Should

the recipient drop out of school, any unused money must be returned to the

Department of Nebraska, American Legion.

8. Contact financial aid office to determine how a scholarship might affect other funding.

9. Winners will be announced through The Nebraska Legionnaire and letters to

selectees. Recipients will receive scholarship funds allotted as follows:

$250 awarded first semester

$250 awarded second semester

(In the case of trimesters or quarters, scholarship funds will be distributed

accordingly.)

(over)

INFORMATION AND INSTRUCTIONS FOR APPLICANTS

1. Completed application and required certifications must be enclosed in the same

envelope and postmarked on or before the application deadline date of

March 1, 2022.

2. Scholarship application must be complete when received. Attachments are not

acceptable. The following are required in order to receive consideration:

a. Copy of completed Scholarship Application. (2 pages)

b. Copy of completed Financial Statement. (2 pages)

c. Certification blocks must be signed by school official, applicant, and parent or

guardian.

d. A school seal or an official rubber stamp must be affixed to school

certification.

3. Mail completed application & financial statement to: MEMORIAL SCHOLARSHIP

PO BOX 5205

LINCOLN NE 68505-0205

Note: Application materials cannot be returned.

4. Incomplete applications will not receive consideration. The sponsors and

American Legion personnel are not responsible for acquiring any data or forms for

applicants. Do not include materials not specifically requested, such as folders,

a resume, pictures, recommendations, transcripts, etc. There are no provisions for

eligibility criteria waivers.

5. Scholarship winners will be notified via first class mail by April 15, 2022.

MAYNARD JENSEN AMERICAN LEGION

2022 SCHOLARSHIP APPLICATION

1.____________________________________________________ 2._______________________

Full Legal Name: Last, First and Middle Marital Status

3._____________________________________________________ 4._______________________

Date of Birth: Month, Day and Year Telephone Number

5._______________________________________________________________________________

Permanent Home Address: Number, Street, City, State, Zip

6._______________________________________________________________________________

Father, Stepfather, or Legal Guardian: Name: Last, First, Middle

7._______________________________________________________________________________

Mother, Stepmother, or Legal Guardian: Name: Last, First, Middle

8.________________________________________________9._____________________________

American Legion Member’s Name Relationship to Applicant

*10.___________________________ *11._____________________________________________

American Legion Post Number Location of American Legion Post

12.______________________________STATUS: Deceased KIA MIA POW

(Name if deceased, KIA, MIA, POW) (Circle One)

13. List your school, community or church activities in which you have participated:

__________________________________________________________________________________

14. List jobs (including summer employment) you have held in the past three years. Explain the kind

of work, employer, dates of employment and hours per week.

__________________________________________________________________________________

15. Indicate name of Nebraska college you will attend: ______________________________________

Full mailing address of college______________________________________________________

Phone number of college___________________________________________________________

16. What career are you planning to pursue?

__________________________________________________________________________________

17. Please indicate in a 50 word or less essay why you have chosen this profession. _______________

__________________________________________________________________________________

*This information must be included in order to verify Dept. of Nebraska Legion membership.

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PLEASE NOTE: 1. Attachments are not acceptable

2. All questions must be answered or N/A (not applicable) indicated

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MJAL/22

SCHOOL CERTIFICATION

HIGH SCHOOL/COLLEGE RECORD - This section is to be completed by high school official

or college registrar.

Cumulative Grade Point Average (GPA) based on the scale of A = 4.0, as of graduation or completion of

first semester 2021-22 school year: _______________________

Expected Date of Graduation: ___________________________

__________________________________________________

Name of high school/college

_____________________________________________ (AFFIX SCHOOL SEAL OR

Print/Type name of school official and title OFFICAL RUBBER STAMP HERE)

_____________________________________________ _______________________

Signature of School Official Date

NOTE: It is very important that the school's official seal or official rubber

stamp is affixed to this application.

Page 2 of 4

MJAL/22

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FINANCIAL STATEMENT

Student’s Name ________________________________________________________________

Current Address ________________________________________________________________

City/State/Zip Code _______________________________________________________________

Please complete both sides of this statement as accurately as possible. NOTE: If your parents are

divorced, separated or single, use information based on the parent who will provide the financial

support for your education.

Section I. Information/Status/Home Data

1. Student’s Name 1. ___________________

2. State of Legal Residence 2. ___________________

3. Parent(s) Marital Status: Single (S) Married (M) 3. ___________________

4. Number of Family Members at Home

(include student, parent(s), and other dependents) 4. ___________________

5. In addition to applicant, how many other family

members attending college during 2022-23? 5.

Section II. Parent Income and Expense Information

6. Estimated Adjusted Gross Income 2021 6.___________________

7. Parent(s) Untaxed Income 2021 (include social security benefits, 7.___________________

ADC, child support, etc.)

8. Medical/Dental Expense Paid in 2021 (not covered by insurance) 8.___________________

9. K-12 Tuition Paid 2021 (exclude student applying for scholarship) 9.___________________

Section III. Student Income and Asset Information

10. Estimated Student’s Income 2021 10.___________________

11. Student’s Untaxed Income 2021 11.___________________

12. Student’s Assets and Savings 12.___________________

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NOTE: All questions must be answered or N/A indicated for application to be considered

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MJAL/22

Section IV. Current Parent Asset Information

13. Parent(s) Cash and Savings 13.___________________

14. Market Value of Home 14.___________________

15. Unpaid Mortgage on the Home 15.___________________

16. Value of other Real Estate/Investments

(present value of stocks, bonds, CD’s, trust, etc.)

EXCLUDE RETIREMENT PER FASA?? 16.___________________

17. Debt Against Real Estate or Investments 17.___________________

CERTIFICATION

We certify that to the best of our knowledge, the information contained in this application and financial

statement is correct and complete.

Applicant’s Signature:

______________________________________________________________________

Applicant’s Name (Typed or Printed):

______________________________________________________________________

Parent’s or Guardian’s Signature:

______________________________________________________________________

Parent’s or Guardian’s Name (Typed or Printed):

______________________________________________________________________

Date: _________________

PLEASE REVIEW THIS APPLICATION TO MAKE SURE THAT ALL

QUESTIONS HAVE BEEN ANSWERED COMPLETELY AND ACCURATELY

.

INCOMPLETE APPLICATIONS WILL BE REJECTED.

Application Deadline Date - March 1, 2022

Mail completed application & financial statement to:

MEMORIAL SCHOLARSHIP

PO BOX 5205

LINCOLN NE 68505-0205

Page 4 of 4

MJAL/22

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