Please fill in all fields, if you can't answer, put N/A (not applicable).
Name (first, middle, last):
SSN:
DOB: (dd/mm/yy)
Home Phone:
Cell Phone:
Street Address:
City:
State:
Zip:
Email:
 
 
Name of Parent / Guardian:
Home Phone:
Cell Phone:
Does applicant live with parents?
What is parents' current marital status?
What is father's (guardian's) job?
What is mother's (guardian's) job?
Name of your high school:
GPA Weighted:
GPA Un-weighted:
ACT Composite:
Are you taking it again? Y/N (If yes, put highest to date.)
How many years at this school?
Name of previous school if applicable:
Who is your high school counselor?
Phone:
Fax:
Email:
 

COLLEGES/UNIVERSITIES for which scholarship is requested in order of your preference: Our committee considers your scholarship preferences strongly in recommending you for scholarships; therefore if you change your preferences, please let us know.

[REMEMBER YOU MUST ALSO APPLY FOR ADMISSION AND FOR FINANCIAL AID TO THESE SCHOOLS.]

 
A) Name:
A) Have you applied for this school yet? (Yes or Not Yet)  
A) Have you been accepted? (Yes, No, N/A)
B) Name:
B) Have you applied for this school yet? (Yes or Not Yet)
B) Have you been accepted? (Yes, No, N/A)
C) Name:
C) Have you applied for this school yet? (Yes or Not Yet)
C) Have you been accepted? (Yes, No, N/A)
Major field of study you plan to pursue:
Would you consider an available scholarship to a school NOT on your list above? (Y/N)
Do you plan to attend college in Louisiana?  (Yes, No, Undecided)
 

For Tulane Legislative Scholarships only, we must know your legislators. Check your district, go to http://www.legis.state.la.us and enter your address. Last names are sufficient.

 
Louisiana State Senator:
Louisiana State Representative:
 
HAVE YOU APPLIED FOR OR BEEN AWARDED OTHER SCHOLARSHIPS ?  Please indicate below.
A) Name of Award / Provider:
A) Pending or Granted:  
A) Notification Date: (dd/mm/yy)
A) Amount:
B) Name of Award / Provider:
B) Pending or Granted:
B) Notification Date: (dd/mm/yy)
B) Amount:
C) Name of Award / Provider:
C) Pending or Granted:
C) Notification Date: (dd/mm/yy)
C) Amount:

 

Describe your work experience during the past four years. Indicate the name of your employer, your position,  dates of employment, the number of hours worked each week, and the salary for each job (Answer each part of the question for each employer in the space below):

 
Total estimated senior year income?  
 

List all school activities you have participated in during the past four years. Indicate all special awards and honors: (Include name of activity, number of years of participation, and any special honors or awards.) (Answer each part of the question for each activity in the space below):

 
 

List all community activities you have participated in without pay during the past four years. Indicate all special awards/honors: (Include name of activity, number of years of participation, and any special honors or awards.) (Answer each part of the question for each activity in the space below):

 

 

PERSONAL STATEMENTS:

A. In the space provided below, make a statement of your plans as they relate to your educational and career objectives and future goals:

 
 

B. In the space provided below, report any unusual or personal circumstances that you feel warrant attention by the scholarship awards committee.

 
C. Did you receive a Jefferson Dollars for Scholars Enrichment Scholarship in either elementary or middle/junior high?
If so, what grade?
What program did you attend?
 
 
OPTIONAL QUESTIONS:
Did your parents attend college ?
Did your parents graduate from college?
Did you attend an ACT class sponsored by Jefferson Dollars for Scholars?
Are you of Italian American descent, a requirement for one Award?
Would you be eligible for a minority scholarship offered by a university?
How old were you when you decided to go to college?
Do you have a computer in your home now?
Do you have a desktop computer to take to college?
Laptop?

     

FINANCIAL INFORMATION FOR THE YEAR 2009    

    This section must be completed by

parent/guardian of applicant!

 

  • Our process requires that you submit this information OR a copy of your 2007 tax returns.

  • All financial information will be kept confidential.

  • This form may be mailed separately to our offices, but we MUST receive it for your child’s application to be complete. Our mailing address is: 3330 N. Causeway Blvd., Suite 429, Metairie, LA 70002.

 

      Louisiana requires that you to complete and submit a FAFSA (Free Application for Federal Student Aid) form for your child to receive TOPS funding, the state-funded tuition. The reason for this is that all colleges receive a combination of state and federal funding to support students. The FAFSA form generates federal funding that universities rely on. Jefferson Dollars for Scholars does not see or require this form.

 
A. APPLICANT'S NAME:
High School:
B. PARENTS' INCOME, EXPENSE, AND ASSET DATA FOR THE YEAR 2008:

1. Income earned from work by**: Father

**Form 1040 – line 38, Form 1040A – line 22, Form 1040EZ – line 2

Income earned from work by **;

Mother

**Form 1040 – line 38, Form 1040A – line 22, Form 1040EZ – line 2

Guardian, Step Parent, Other **

2. All other income:

3. Total U.S. income tax expected to be paid:

4. Untaxed income and benefits: Social Security, AFDC, ADC, other :

Savings (in addition to income):

Cash, bonds, saving accounts, C.D’s, Pensions, etc [NOT including value of home]