EDWARDS SCHOLARSHIP FUND

EDWARDS SCHOLARSHIP FUND

APPLICATION

2010-2011

200 Clarendon Street, 27^th Floor, Boston 02116

Call: 617.654.8628 Email:esfund@yahoo.com www.esfund-boston.org

Name (in full) _____________________________________________________________________________________

(First) (Middle) (Last)

Home Address______________________________________________________ Zip Code___________

Home Phone____________________________ Your Cell Phone___________________________

Your Email Address_____________________________________

Date of Birth_______________________ Place of Birth___________________________ Sex____

Father (or guardian’s name) in full_________________________________________________________

Occupation________________________________________________________

Have you lived in Boston all your life? ______

If not, dates you lived in Boston____________________________

Institution(s), if any, to which you have applied for 2010-2011:

__________________________________________________________________________________

College or university you expect to attend in 2010-2011:_____________________________________

Will you live on campus?_____________________

Program you will be in: _______________________________________________________________

Leading to: ______________________________________________________________________

(Expected degree and year)

What school (if any) are you presently attending? __________________________________________

Please list previous schools attended:

High School

__________________________________________________________________________________

(Name) (Address) (Date of graduation)

College or University

__________________________________________________________________________________

(Name) (Address) (Degree received & year)

List school or college activities in which you have participated.

(athletics , clubs, school paper, dramatics, music, etc.)

__________________________________________________________________________________

List your activities outside of school or college.

(clubs , organizations, community affairs, etc.)

__________________________________________________________________________________

State briefly your present plans for a career and your reasons for this choice.

__________________________________________________________________________________

Have you previously applied to the Edwards Scholarship Fund? ________

What was the year? ___________Did you receive a scholarship? _________ Amount? ____________

Have you applied, or do you intend, to apply elsewhere for a scholarship or loan? ________

Please give details. ______________________________________________________________

_________________________________________________________________________________

List all scholarships and loans that you have received, including all Edwards Awards.

Academic Year Source Amount Scholarship or Loan

____________ ____________________________________ __________________ _______________

EMPLOYMENT RECORD

Please list the names and addresses of all employers and state the type of work, dates of employment and salary received.

1.____________________________________________ ________________________________________

(Employer) (Type of work)

____________________________________________________________ $_____________per hour $__________________per week

Employed from ___________________to___________________ ______________________

(Mo./Day/Yr.) (Mo./Day/Yr.) (Hours per week)

2._____________________________________________ _________________________________________

(Employer) (Type of work)

_____________________________________________________________ $____________per hour $__________________per week

Employed from ______________to______________ _______________________

(Mo./Day/Yr.) (Mo./Day/Yr.) (Hours per week)

3._____________________________________________ _________________________________________

(Employer) (Type of work)

_____________________________________________________________ $____________per hour $___________________per week

Employed from _______________to _____________ ____________________

(Mo./Day/Yr.) (Mo./Day/Yr.) (Hours per week)

4.____________________________________________ __________________________________________

(Employer) (Type of work)

____________________________________________________________ $_____________per hour $__________________per week

Employed from _______________to______________ ___________________

(Mo./Day/Yr.) (Mo./Day/Yr.) (Hours per week)

Do you plan to work during the school year of 2010-2011? Please give the details.

PARENTS’ FINANCIAL STATEMENT

This two page statement is part of your daughter’s/son’s application for scholarship aid. It must be returned to the Edward’s Scholarship Fund, 200 Clarendon Street, 27^th Floor, Boston, MA 02116, on or before March 1, 2010.

We request this information in order to make awards carefully. Our aim is to determine the financial need of all applicants and to distribute our available funds fairly. You are therefore urged to supply any additional information which seems significant to you. All information submitted will be treated confidentially. NOTE: If applicant is self-supporting and/or married he/she should consult with the office of the Edwards Scholarship Fund regarding the process for filling out this form.

Call: 617-654-8628 Email: esfund@yahoo.com www.esfund-boston.org

_________________________________________

Name of Applicant: _______________________________________________________

(First) (Middle) (Last)

_______________________________________________________________________________________________

Father or Guardian: Mother:

1. Name_________________________________________ Name__________________________________________

2. Home Address__________________________________ Home Address___________________________________

3. Employer______________________________________ Employer_______________________________________

4. Nature of business ______________________________ Nature of business________________________________

Parent’s Annual Income (before taxes):

Actual 2009 Estimated 2010

Father $________________ Father $________________

Mother $_______________ Mother $_______________

TOTAL: $______________ TOTAL: $______________

Do you own your home? ________

If yes, what is the estimated market value? $________________

Do you have a mortgage? __________What is your monthly payment? ________________

Do you own other real estate? _________

If yes, what is the estimated market value? ________________

If you rent your home, what are your monthly payments? _______________

Parents’ Financial Statement (continued)

Please list all brothers and sisters of the applicant and indicate the extent of financial support they are receiving during the 2009-2010 academic year.

Name School/College/ or Occupation Age Support Given

______________________________ _________________________ _____ _____________

Please use this space to explain any special family circumstances that the fund should know about; for example,

divorce, separation arrangements, dependencies, illnesses, special housing problems, etc.

______________________________________________________________________________________

Please submit this financial statement with your daughter’s/son’s application.

In addition, we will need a copy of your W-2 Tax Forms by May 15^th.

Signatures of Both Parents:_________________________________________

_________________________________________

Date_______________________