SELECTION CRITERIA:

1. Female Head of Household, primary wage earner of the family.
2. Applicants should be individuals pursuing post high school training or certification programs not necessarily requiring a baccalaureate degree.
3. The recipient must use the scholarship to attend an educational institution that is accredited and normally maintains a regular faculty and curriculum and normally has a regularly enrolled body of students in attendance at the place where its educational activities are regularly carried on.  This scholarship can fund  a certification program such as law enforcement or fire training education at a technical/trade school or a community college.

4. Financial need is determined by consideration of annual family income.
5. Must be a resident of the Zonta International District 10 and a U.S. Citizen.
6. Consideration shall be given to good citizenship, character, reputation, moral and ethical standing drawn from a personal interview.

APPLICATION PROCEDURES:

1. Complete the scholarship application fully and neatly.
2. Enter your name on all evaluation forms.
3. Solicit letters of recommendation from three people not related to you who know you well.  Have references send the forms directly to the Zonta contact listed below before the deadline.
4. Write a paragraph regarding your educational goals and career selection.
5. Prepare the “Financial Fact Sheet” documenting a proof of need, and turn it in with your completed application to the Zonta contact before the deadline
6. Everyone must submit a completed copy of the family’s Income Tax return used in preparing the “fact sheet”

SELECTION COMMMITTEE:

The Zonta International District 10 Scholarship committee is composed of members of the Zonta International District 10 membership.

SCHOLARSHIP AWARD:

The scholarship award is $1,000 paid to the institution providing the certification /training program in the name of the recipient.

Recipient must take a minimum of 6 hours.

DEADLINE FOR SUBMISSION:  March 1, 2010

MAIL SCHOLARSHIP PACKET TO:     Zonta International District 10 Foundation

            Attn: Janis Wood

            3 Surrey Lane

            McLoud, TX 74851

For information contact: 

Janis Wood

405-273-3918 or mailto:ltgov@zontadistrict10.org

PART  1

PERSONAL DATA

Name of Student______________________________________   Phone_________________

Address_____________________________________________   Zip___________________

Date of Birth:_____________________  Marital Status:____________   Dependents_______

EDUCATIONAL BACKGROUND:

High School:________________________________________________________________

Date of Graduation:_________________________________ Grade Point Average:_______

School Presently Attending:____________________________________________________

Address:____________________________________________________________________

Current Year:_____Freshman     _____Sophomore    _____Junior     _____Senior

Cumulative Grade Point Average:___________   Expected Date of Graduation:____________

SAT/ACT Score:______________    College Accepted at:_____________________________

FINANCIAL DATA:

Do you receive income from your family (parents or spouse) ?______Monthly amount_______

Are you presently receiving financial assistance from any other source?________________

Employer:______________________________________________Salary:_________________

Address:________________________________________________ Zip:___________________

Please attach the required financial data sheet and most recent IRS return.

WORK EXPERIENCE:     List below all work experience starting with the most recent.

_____________________________________________ from __________ to _______________

_____________________________________________ from __________ to _______________

_____________________________________________ from __________ to _______________

_____________________________________________ from __________ to _______________

COMMUNITY SERVICE ACTIVITIES:  Please list all of the community activities in which you have been involved.

REFERENCES:

List names and addresses of persons submitting references:

Academic Reference

Name:______________________ Phone:___________ E-Mail:______________________________

Employer Reference

Name:_____________________ Phone:____________E-Mail:_______________________________

Character Reference

Name:______________________Phone:___________E-Mail________________________________

STATEMENT OF ECONOMIC NEED AND CAREER PLANS: Please write a brief (150 words or less) paragraph that describes your career goals and a statement of need for financial assistance.

Scholarship recipient will be notified by May 1, 2010

FINANCIAL FACT SHEET

Student Name:_____________________________ Social Security Number:________________

Address:______________________________________________________________________

Date of Birth:_______________________________ Marital Status:_______________________

Have you enclosed you most recent income tax return?

If you are dependent on your parent(s) for support complete Section A.  If you are independent from the support of your parent(s) complete Section B.

Section A: (If dependent on parents for support)

Total number of exemptions for family:______

Adjusted gross income of family  $__________

Income tax paid  $________________

Income earned by father: $_______________

Income earned by mother: $_______________

Parent’s marital status:_________________________

Number of members in the family:________________

Number of family members in college:__________

Child support received by the family? $_____________

Other family untaxed income or benefits:$____________

Student’s income earned from work $__________________

Student’s other untaxed income or benefits $________________

What is the age of the older parent:_________

Parent’s cash, savings, and checking: $______________

Parent’s real estate and investment value (other than home) $____________

Parent’s real estate and investment (Other than debt) $______________

Parent’s business value:$_________________  Parent’s business debt: $___________

Section B: (If not dependent on parents for support)

Total number of exemptions for family:______

Adjusted gross income of family  $__________

Income tax paid  $________________

Income earned by work spouse: $_______________

Income earned by work of applicant: $_______________

Number of dependent children:__________

Student’s other untaxed income or benefits $________________

Student’s cash, savings, and checking: $______________

Student’s real estate and investment value (other than home) $____________

Student’s real estate and investment (Other than debt) $______________

Student’s business value:$_________________  Student’s business debt: $___________