MARYLAND HOUSE OF DELEGATES SCHOLARSHIP
APPLICATION
**Information provided below is for the use of the Scholarship Committee in considering your application.
It will be kept confidential. Please return this application, an official transcript or copy of last semester grades, and an essay to: Delegate Michael L. Vaughn, 1891 Brightseat Road, Landover, MD 20785
NAME:
_______________________________________________________________________________
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DATE OF BIRTH: __________ TEL.#: (____) ____-_____ SOC. SEC.#:
_____-____-_____
ADDRESS:
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CITY: _____________________________ STATE: _______________ ZIP:
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LENGTH OF RESIDENCY AT CURRENT ADDRESS ___ U.S. CITIZEN: yes: __ no: __
I am a legal resident of Maryland Legislative District 24 and would like to be considered for a House of Delegates Scholarship to attend (name of institution): ____________________________
_____________.
I will enter school in September ________ as a: (Check one) freshman ____;
Sophomore_____; junior ______; senior ______; Graduate ______. I will be
a ______full-time student or a _____ part-time student. Received Letter of
Acceptance: yes /no
I graduated from, or will graduate from ____________________ in
_____________ 20____.
List previous colleges attended: |
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Degree or Major you will pursue: (1) |
(2) |
SCHOLASTIC INFORMATON (High School Seniors):
SAT SCORES: VERBAL _______ MATH _________ DATE TAKEN
__________________
ACT SCORES: VERBAL _______ MATH _________ DATE TAKEN
_________________
GRADE POINT AVERAGE_______________
*****You must attend a Maryland school or to receive this scholarship to attend an out of state school, you must have your academic major approved “Unique” by the Maryland
Higher Education Commission. *****
List jobs, both part and full-time, held during the past two (2) years or N/A:
List number and ages of your dependent children. Give year and place of enrollment for any college students or N/A:
List other financial aide you have accepted or expect to receive (Attach a separate sheet if needed):
Indicate the number of students attending college/technical schools in your household (including yourself)?
Indicate Family’s yearly Income: $ |
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Total Number of |
Dependent Children in Household: |
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List special financial burdens or |
expenses: |
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On a separate sheet, provide any additional information, which will help the Scholarship Committee in their consideration of your application.
(Students Signature) |
(Date) |
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(Parent/Guardian Signature) |
(Print |
Parent/Guardian Name) |
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(Parent/Guardian Signature) |
(Print |
Parent/Guardian Name) |
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