Fillable APPLICANT CHECKLIST CITY OF GREENACRES 2021 EDUCATIONAL SCHOLARSHIP (City of Greenacres)

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APPLICANT CHECKLIST CITY OF GREENACRES 2021 EDUCATIONAL SCHOLARSHIP (City of Greenacres)

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CITY OF GREENACRES
2021 EDUCATIONAL SCHOLARSHIP
APPLICATION
Deadline: April 2, 2021 – 6:00 p.m.
Please return application to:
City of Greenacres
Community & Recreation
Services Department
501 Swain Blvd.
Greenacres, FL 33463
Phone No. 561-642-2180
Applicant Name: No.
(Assigned by City)
Please be sure to include the following documents with your application:
Application with all required signatures
Cover Letter
Copy of birth certificate or legal residency document
Certified and sealed transcript from high school or college
Letter of Recommendation
Copy of 2020 Income Tax Returns for Applicant, Parent(s), and Guardian(s),
with verification of signatures(s) and filing date.
APPLICANT CHECKLIST
City of Greenacres – 2021 Scholarship Application Page 2
CITY OF GREENACRES
2021 EDUCATIONAL SCHOLARSHIP
APPLICATION
Deadline: April 2, 2021 – 6:00 p.m.
Please return application to:
City of Greenacres
Community & Recreation
Services Department
501 Swain Blvd.
Greenacres, FL 33463
Phone No. 561-642-2180
The City of Greenacres offers five (5) $1,500 Educational Scholarships; one of which is awarded to an applicant who
is an outstanding athlete.
App
licants must:
• Reside within the municipal boundaries of the City of Greenacres;
• Be a U.S. Citizen or a lawful permanent resident of the United States;
• Be a High School Senior, Graduate, have obtained a GED, or are attending college;
• Demonstrate a financial need.
Along with your Scholarship Application, please provide the following:
• A c
over letter that provides detailed information about your background and family dynamics, your higher
education and career objec
tive, work experience, if any, and any other information that you would like to provide
to the Committee for their consideration during the evaluation;
• Birth Certificate or proof of lawful residency in the United States;
• Letter of Recommendation;
• Certified and sealed copy of High School or College Transcript;
• Copy of 2020 Income Tax Returns for Applicant, Parent(s), and Guardian(s), with verification of signatures(s)
and filing date.
The S
cholarship Award must be used within twelve (12) months of the year awarded or the remainder of the funds will
be forfeited back to the City of Greenacres. All funds will be applied towards books and/or academic, technical or
vocational school tuition. Verification of expenditures will be made by the City through the college of your choice, to
assure that the funds are expended on educational books and tuition.
APPLICANT INFORMATION
(Please Print)
Full Name: Date of Birth:
Permanent Address:
Primary Phone No.: Alternate Phone No.:
Email Address:
Please Check One: High School Senior High School Graduate College Student
Social Security Number*:
*The requirement of your Social Security Number is mandatory. Pursuant to Chapter 119.071(5), F.S.,
the City is authorized to collect Social Security Numbers if it states in writing the purpose for its collection.
The City of Greenacres is requesting your Social Security Number for the purpose of providing
scholarship funds for college tuition in the event such funds are awarded.
EDUCATIONAL BACKGROUND
High School or College:
H.S. Graduate Date:
Four (4) year cumulative GPA:
S.A.T. Score:
Senior Year/College GPA:
A.C.T Score:
HONORS AND AWARDS
Honors and/or Awards Received
1.
3.
2.
4.
City of Greenacres – 2021 Scholarship Application Page 3
COMMUNITY SERVICE
No. of Hours
Service Provided
GRANTS, FINANCIAL AID & OTHER SCHOLARSHIPS APPLIED FOR AND/OR RECEIVED
Agency
Applied For
Received
Amount of Grant/Scholarship
1.
2.
3.
EXTRA-CURRICULAR AND/OR SPORTS ACTIVITIES
1.
4.
2.
5.
3.
6.
PARENT/GUARDIAN DATA
Father/Guardian:
Mother/Guardian:
Employer:
Employer:
Employer’s Address:
Employer’s Address:
No. of Siblings: Ages of Siblings:
FAMILY INCOME DISCLOSURE
Total Annual Family Income (check one)
Under $25,000 $50,000 - $100,000
$25,000 - $50,000 Over $100,000
ALL FAMILY INCOME THAT SUPPORTS THE APPLICANT MUST BE REPORTED.
A complete copy of the 2020 Income Tax Returns (1040EZ, 1040, 1040A, etc.)
for yourself, your parent(s), and/or guardian(s), must be attached.
AFFIDAVIT
I certify that I am a resident of the City of Greenacres, a U.S. citizen or lawful permanent resident of the United States,
and that I am submitting this scholarship application based upon my need for financial assistance for books and tuition.
I further certify that the information provided in this application is true and correct and I understand that false and/or
fraudulent statements within this application may be grounds for disqualification.
Applicant Signature: Date:
Parent/Guardian Signature: Date:
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APPLICANT CHECKLIST CITY OF GREENACRES 2021 EDUCATIONAL SCHOLARSHIP (City of Greenacres)

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Completed 19 February 2021

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