Scholarship Application Form

Scholarship Award Application

The applicant must complete this form. All questions must be answered. If any question does not apply, write “NA” in the space provided. He/she must then sign this sheet and have one parent, grandparent or guardian approve the application.

First Name*

Middle Initial

Last Name*

Address*

Use Google Smart Search for Address

Address 1:

City:

Country:

State/Province:

Postal Code:

Phone Number* - -

Email*

Name of High School or College you are currently attending*

Year of graduation*

Date of Birth*

Mother's Name*

Father's Name*

PLEASE PROVIDE THE NAME OF THE PARENT, GRANDPARENT OR GUARDIAN WHO IS THE EMPLOYEE OF THE CIM-LRD MEMBER FIRM OR WHETHER YOU ARE THE ELIGIBLE EMPLOYEE, COOP STUDENT OR INTERN:

Name*

Relationship to Applicant*

CIM-LRD Member Company*

I certify that the information in this application is complete and accurate to the best of my knowledge and belief.
Signature of Applicant*

Date of Applicant Signature*

Signature of Parent or Guardian, if applicable

Date of Parent or Guardian Signature*

The Executive Committee of the CIM-LRD reserves the right to accept or reject any recommendation of the Scholarship Awards Committee. The decision of the Executive Committee is final.

General Information

Name of current High School or College*

Address of current High School or College*

Use Google Smart Search for Address

Address 1:

City:

Country:

State/Province:

Postal Code:

Intended Major (Business, College, other)*

High School Class Standing:
Total No. in Class*

Class Rank*

If currently in college, identify what year and expected date of graduation*

Scholastic Honors (Indicate Year Obtained)

Scholastic Aptitude Test (SAT) Scores - Math

Scholastic Aptitude Test (SAT) Scores - English

Achievement Tests (if applicable) - Math

Achievement Tests (if applicable) - English

Achievement Tests (if applicable) - Other

Extracurricular activities (at school, include offices held)

Outside activities (May include community, civic, religious, offices held)

In what ways have you helped your family and/or community, organizations, etc.?*

Describe your hobbies and interests and their importance to you.*

What honors, awards, prizes, or distinctions have you received?*

Financial Information (Need not be completed)

If a dependent, number of children in family (show ages)

Parents’ combined gross income from 2020 Federal Tax Return

Parents’ combined taxable income from 2020 Federal Tax Return

Explain any large family or personal expenditures which might adversely affect ability to support tuition during the school years (if any).

Show applicant’s approximate earnings record:

Job

Year

Duration

Earnings

Would you like to add a second job?

Job 2

Year (Job 2)

Duration (Job 2)

Earnings (Job 2)

Would you like to add a third job?

Job 3

Year (Job 3)

Duration (Job 3)

Earnings (Job 3)

Tuition

If known. If applicant has not decided on which college to attend, please estimate:

Tuition*

On campus living expenses*

Other*

Total*

Percent of tuition/college expenses being paid by applicant*

College or University attending or that you will attend, if already decided*

To what College(s) or University(s) have you been accepted?*

Full-time or part-time student?*

List any scholarships applied for (include amounts); indicate those received.

Describe College Course of Study (Major/Minor)*

What is your Career Objective?*

What Experience or Activity do you believe has built your character?*

What person has influenced your growth as a young adult and why?*

Please upload a copy of your most recent high school or college transcript of grades

(doc, docx, jpeg, jpg, pdf)

Please upload a letter of recommendation

(doc, docx, jpeg, jpg, pdf)

Letters should be from a representative of the school where you are currently in attendance that reflects the standing of the applicant in that particular class, and any other comments which the school representative wishes to make.

ESSAY (150 words minimum)

“WHY DO YOU FEEL THAT YOU ARE DESERVING OF THIS AWARD?”

Please upload your essay*

(doc, docx, jpeg, jpg, pdf)